Athletic training chapter 22

The costoclavicular ligament

It prevents lateral and upward displacement of the clavicle.

The interclavicular ligament

It prevents lateral displacement of the clavicle.

What is the significance of the load and shift test?

It provides an idea of the adequacy of the glenoid lip.

Grade 1 sprain

Little pain and disability, with some point tenderness but no joint deformity

Identify the characteristics of the fractures of the humeral shaft.

-They are comminuted. -They are transverse.

Identify the factors that contribute to scapular dyskinesis

-coracoid tenderness -scapular malposition

Identify the subacute and chronic conditions that result due to any traumatic injury to the shoulder joint.

-synovitis -bursitis

Identify the anterior structures of the shoulder complex that should be palpated for determining pain sites and deformities.

-the bicipital groove -the clavicular shaft -the coracoid process

progressive stages of shoulder impingement as described by Neer

1. It involves point tenderness over the supraspinatus or biceps tendons and pain during abduction that becomes worse at 90 degrees. 2. It involves a permanent thickening and fibrosis of the supraspinatus and biceps tendons and at times the subacromial bursa. 3. It involves a possible partial muscle tear and permanent thickening of the rotator cuff and the acromial bursa with scar tissue.

grades of acromioclavicular sprains

1. Point tenderness and discomfort during movement at the junction between the acromion process and the outer end of the clavicle 2. Tearing or rupture of acromioclavicular ligaments, with associated stretching of the coracoclavicular ligament 3. Complete rupture of the acromioclavicular and coracoclavicular ligaments 4. Posterior separation of the clavicle 5. Tearing of the trapezius and deltoid attachment to the clavicle and acromion

steps involved in the load and shift test.

1. the athletic trainer places one hand over the patient's shoulder to stabilize the scapula 2. the athletic trainer uses his/her other hand to grasp the humeral head between thumb and index finger 3. the athletic trainer applies a stress load 4. the athletic trainer assesses the translation of the humerus in both an anterior and posterior direction

A grade 1 acromioclavicular sprain requires use of a sling for _____.

3 or 4 days

What does a positive clunk test indicate?

A tear in the glenoid labrum

Pain in the acromioclavicular joint with O'Brien's test may indicate _____.

AC joint pathology

Where does the subclavian artery become the axillary artery?

At the outer border of the first rib

grade 3 sprain

Complete dislocation with gross displacement of the clavicle at its sternal junction, swelling, and disability

acromioclavicular sprains grade 4

Complete disruption of the acromioclavicular ligament, with the coracoclavicular ligaments remaining intact in some cases

acromioclavicular sprains grade 5

Complete loss of both the acromioclavicular and the coracoclavicular ligaments

acromioclavicular sprains grade 6

Displacement of the clavicle inferior to the coracoid behind the coracobrachialis tendon

True or false: The posterior sternoclavicular ligament prevents lateral displacement of the clavicle.

False - The anterior and the posterior sternoclavicular prevent upward displacement of the clavicle, whereas the interclavicular prevents lateral displacement of the clavicle.

True or false: In the context of the trauma resulting in a sprain to the sternoclavicular joint, the complete rupture of the sternoclavicular and costoclavicular ligaments is a characteristic of grade 2 stage.

False -A grade 3 sprain, which is the most severe, presents a picture of complete dislocation with gross displacement of the clavicle at its sternal junction, swelling, and disability, indicating complete rupture of the sternoclavicular and costoclavicular ligaments. A grade 2 sprain displays subluxation of the sternoclavicular joint with visible deformity, pain, swelling, and point tenderness.

In the context of the lesions that can be caused by shoulder dislocation, a _____ lesion is caused by the compression of the cancellous bone of the head of the humerus against the anterior glenoid rim that creates a divot in the humeral head.

Hill-each

How is the clavicle shaped?

It is a slender, S-shaped bone.

In the context of the lesions that can be caused by shoulder dislocation, which of the following is true of the superior labrum anterior/posterior lesion?

It is caused by an injury to the superior aspect of the labrum that begins posteriorly.

acromioclavicular sprains Grade 1

No disruption of the acromioclavicular joint, indicating only mild stretching of the acromioclavicular and coracoclavicular ligaments

What should be done immediately after a sternoclavicular sprain?

POLICE should be used.

acromioclavicular sprains grade 2

Partial displacement and prominence of the lateral end of the clavicle when compared with the unaffected side

The term _____ describes several factors that contribute to scapular dyskinesis.

SICK scapula

Grade 2 sprain

Subluxation of the sternoclavicular joint with visible deformity, pain, swelling, and point tenderness

A soccer player falls on the tip of his shoulder while tackling the ball. He experiences excruciating pain when he tries to move his shoulder. The pain enhances when he attempts to flex, adduct, or internally rotate his arm. He complains of tenderness in the affected area when the physician palpates the subacromial space. The impingement test conducted on him exhibits a positive result. In this scenario, the player probably has _____.

shoulder bursitis

During a baseball tournament, a player accidentally hits Paul's left shoulder. He is immediately rushed to the hospital where the physician conducts several preliminary tests on him. He has pain when he is asked to flex, adduct, and internally rotate his arms. He experiences tenderness when the physician palpates the subacromial space. Moreover, the impingement test exhibits a positive result. In this scenario, Paul has _____.

shoulder bursitis

The _____ is located between the coracoacromial arch and the glenohumeral capsule.

subacromial bursa

_____ is a brief, transient occurrence in which the humeral head quickly returns to its normal position relative to the glenoid.

subluxation

A true statement about the clavicle is that it _____.

supports the anterior portion of the shoulder

A patient who wants to continue activity during stages III and IV of shoulder impingement may require _____.

surgical intervention

During the anterior observation of an injury to the shoulder complex, a therapist would check if _____.

the lateral end of the clavicle is prominent

A feature of the sternoclavicular joint is that it is _____.

the only direct connection between the upper extremity and the trunk

Winging of the entire medial border of the scapula at rest is caused by fatigue of the _____.

trapezius

True or false: With all grades of acromioclavicular sprain, an aggressive rehabilitation program involving joint mobilization, flexibility exercises, and strengthening exercises should begin immediately after the recommended period of protection.

true

What happens during the anterior drawer test?

The patient lies supine with arms externally rotated 10 degrees.

_____ is a posterior structure of the shoulder complex that should be palpated for determining pain sites and deformities.

The scapular inferior angle

episodes of shoulder instabilities: Microtraum

They are created by repetitive use of the shoulder, usually involving some faulty biomechanics, that leads to soft-tissue laxity.

Identify a true statement about the second group of muscles acting on the glenohumeral joint.

They include the coracobrachialis.

episodes of shoulder instabilities: traumatic episodes

They occur from one or more situations that cause a complete or partial joint displacement.

episodes of shoulder instabilities: Atraumatic episodes

They occur in patients who voluntarily or involuntarily displace the shoulder joint because of inherent ligamentous laxity.

Identify a true statement about the first group of muscles acting on the glenohumeral joint.

They originate on the axial skeleton.

True or false: A fracture of the lesser tuberosity may occur as the subscapularis tendon avulses its attachment in posterior glenohumeral dislocation.

True

Susanna is a gymnast. While practicing a spinning move, she loses balance and injures her right shoulder. She experiences moderate pain and disability and is unable to touch the left shoulder with her right hand. She carries her right arm in external rotation and slight abduction. In this scenario, Susanna has _____.

an anterior glenohumeral dislocation

Ken injures his shoulder while playing soccer. He visits Selina, a physiotherapist. Before beginning the therapy, she checks Ken's clavicular shaft. She also examines the contour of his deltoid muscle. In this scenario, the method of assessment implemented by Selina is referred to as a(n) _____ observation.

anterior

Recurrent _____ instability may cause the athlete who throws to complain of pain or clicking or to experience what is described as a dead arm syndrome in the cocking phase of the overhead throwing motion.

anterior

A patient lies supine with arms abducted 45 degrees, horizontally adducted 10 degrees, and a slight distraction applied to his or her glenohumeral joint during the _____ test.

anterior drawer

In a(n) _____ dislocation, the head of the humerus is forced out of its articular capsule in an anterior direction past the glenoid labrum and then downward to rest under the coracoid process.

anterior/inferior glenohumeral

An injured athlete's arm is abducted at 90 degrees. This is followed by slowly and gently rotating the shoulder externally as far as he or she will allow during the _____ test.

apprehension

The spinal nerve roots from the fifth cervical vertebra through the first thoracic vertebra to create the complex nerve network called the

brachial plexus

In the context of the sternoclavicular joint, the articular disk is placed so that the _____.

clavicle moves on the disk

The subacromial bursa is easily subjected to trauma when the humerus is in the overhead position because it becomes compressed under the _____.

coracoacromial arch

The apprehension test is also known as the

crank test

The most common mechanism in an anterior/inferior glenohumeral dislocation is _____.

forced abduction

With _____, there is excessive translation of the humeral head without complete separation of the joint surfaces.

glenohumeral subluxations

During initial inspection, shoulder pointers may be mistaken for a _____.

grade 1 acromioclavicular sprain

During the clunk test, an athletic trainer first _____.

grasps the elbow with one hand and places the other hand on the posterior humerus

In the context of O'Brien's test, if an individual has a superior labrum anterior posterior (SLAP) lesion, he or she may _____.

hear a clicking within the glenohumeral joint

During the management of the sternoclavicular sprain, _____ is usually maintained for 3 to 5 weeks, followed by graded reconditioning exercises.

immobilization

Winging of the superior medial border of the scapula is likely due to _____.

impingement

A characteristic of the recurrent anterior instability of the shoulder joint is that it may _____.

lead to a positive apprehension test

In the context of the causes of shoulder instabilities, increased laxity of the supportive capsular and tendinous structures leads to _____.

more instability

A feature of the subclavian artery is that it _____.

moves downward laterally behind the clavicle

Shoulder pointers cause a bone bruise and subsequent irritation to the _____.

periosteum

The _____ nerves stem from the brachial plexus and innervate the muscles of the upper extremity.

peripheral

In the context of the progressive stages of shoulder impingement as described by Neer, stage IV involves _____.

possible degeneration of the clavicle

Jim falls from bicycle and lands on his left shoulder. After the injury, he is unable to externally rotate and elevate his left arm. X-ray of the shoulder reveals that the anterior deltoid muscle is flattened and the acromion and coracoid processes are prominent. These are symptoms of _____.

posterior glenohumeral dislocation

The anterior sternoclavicular ligament

prevents upward displacement of clavicle

_____ paralysis leads to wrist drop and an inability to perform forearm supination.

radial nerve

Management of stages I and II of shoulder impingement involves _____.

restoring normal biomechanics

In the context of posterior glenohumeral dislocation, a _____ defect can occur on the anteromedial portion of the humeral head following a posterior shoulder dislocation.

reverse Hill-Sachs lesion

The pathological process of a sprain to the glenohumeral joint often involves the _____ muscles.

rotator cuff