review shoulder anatomy - welcome to ers 4 kids · 2020-03-13 · review shoulder anatomy review...
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Review shoulder anatomy Review the physical exam of the shoulder Discuss some common causes of acute
shoulder pain Discuss some common causes of chronic
shoulder pain Review with some case questions
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Bones:
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Ligaments and cartilage
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Muscles – rotator cuff:
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Muscles – posterior:
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Muscles – anterior:
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Inspection Palpation ROM
Active
Resisted
Passive
Provocative tests Functional tests
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Inspection:
Alignment, bruising, swelling
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Palpation
Anterior joint line
Posterior joint line
Sternoclavicular joint
Acromion
Acromioclavicular joint Trapezius
Long head of biceps
Scapula
Clavicle Supraspinatous
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ROM:
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Rotator cuff
Lift off test; subscapularis
Resisted external rotation;
infraspinatus and teres minor
Empty Can Test;
supraspinatus
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Impingement
Hawkins
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Instability; apprehension
Anterior
Posterior
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Instability
Translation – anterior, posterior, and inferior (sulcus sign)
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Instability
Fowler’s relocation
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Labral tears
O’Brien’s test
Biceps tendonitis
Speed’s
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AC separation
Cross arm adduction
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Clavicle fracture Glenohumeral dislocation AC separation Brachial Plexopathy Neck Injury Labral Tear Rotator Cuff Tear
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Usually from direct trauma Pain and visible defect Middle > Distal > Proximal Treatment:
Sling unless…
▪ Open or risk of breaking skin
▪ Cominution
▪ Shortening
▪ Complete displacement?
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Anterior most common Can be associated with hypermobility
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Direct trauma or fall onto shoulder Tenderness and deformity of AC joint
Treatment: Conservative for I-III; operative for IV-VI
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“Stinger” or “burner” Usually C5-C6 = weakness of deltoid and
biceps and decreased sensation over deltoid Recovers quickly
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Can be acute or chronic Most common are SLAP
tears – superior labrum anterior to posterior
Posterior shoulder pain and pain with overhead activity
Mechanical sensation
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Usually older patients with underlying shoulder complaints who have additional acute injury
Pain with sleeping on shoulder, pain with abduction, loss of pitching velocity
+ Impingement signs with weakness
Often refers to the deltoid
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Impingement Tendonitis Labral tears Rotator cuff tears
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Many structures that can be pinched:
Supraspinatous
Subacromial bursa
Coracoacromial ligament
Biceps
Posterior capsule
Labrum
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Risk factors include repeated overhead activity, shoulder instability, or scapular dyskinesis
Pain with overhead activity or cocking phase of pitching
Important to rehab
Impingement Fibrosis and tendinitis
Tear
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Of rotator cuff Pain with overhead activity with history of
repetitive use
Night pain
Exam similar to impingement with pain at end of passive flexion and with supraspinatous testing
Of biceps tendon Tenderness over biceps
Increased pain with resisted elbow flexion or supination of wrist
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The rotator cuff consists of:
trapezius, supraspinatus, infraspinatus, teresminor
supraspinatus, infraspinatus, subscapularis, teresmajor
supraspinatus, infrapsinatus, subscapularis, teresminor
supraspinatus, infraspinatus, teres major, teresminor
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A football player comes to see you in clinic. He was hit in the shoulder yesterday during practice with a friend’s helmet. He now has pain and swelling in the area of his AC joint. You can feel a deformity on palpation. Which of the following tests would you anticipate would be positive? Fowler’s relocation
Speed’s test
O’brien’s test
Apprehension test
Cross arm adduction test
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A 13 yo pitcher comes into your office with shoulder pain. He plays baseball year round. He has recently started to learn to throw a curve ball. He does not remember any acute injury. He is tender over the area of the humeral physis. Which of the following would not be beneficial in his recovery? Rest from pitching until asymptomatic then slowly
progress back to throwing
PT to strengthen rotator cuff
Working on proper mechanics with a pitching coach
Pitching for multiple teams once he recovers so that he can get more practice