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shoulder

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shoulder

Injuries
- Acute
  - Dislocations
    - Subluxations
      - Rotator cuff strain/tear
- Chronic
  - Instability
    - Subacromial impingement
Dislocations
- Direct Impact
  - Indirect
    - Forced abd + L. rot>
      - Fall outstretched arm
- Usually damage to anterior labrum
  - Bankart lesion
    - Sometimes "bony bankart lesion'
- - Soft tissue damage
    - Capsule
      - Glenohumeral ligament complex
  - - px feels 'popping out'
      - prominent humeral head
        Hollow below acromion
        not smooth compared to opp. side
        damage axillary nerve
        results in decrease sensation Lateral shoulder
        deltoid weakness
    - - TUBS lesions + traumatic dislo/sublux
        T raumatic event giving rise to
        U nidirectional anterior instability with a
        Bankart lesion
        Surgery is usually indicated
        Shoulder instability
      - Bankart Lesion
        common recurrent dislocation and post traumatic instability
        Detatch ant. inf. labrum and ant. capsule from glenoid rim
        conservative/ surgical repair
        Tear to glenoid labrum
      - Tear to glenoid labrum
        SLAP lesion
        Superior Labrum Anterior - Poterior
        compression forces - outstretch hand
        Repeated stress
        Combo disloc/sublux
        possible avulsion frac. long head biceps
        4 types
        conservative
        Fray
        Bucket handle
        Surgery
        Tear away
        Complete pull
      - Treatment for Anterior dislocations
        Acute
        Ice
        Sling
        X-ray - rule out fracture
        Pain
        Soft tissue damage
        recurrent dislocation treated for soft tissue damage
        Stability rehabilitation
        If recurrent refer surgery
  - Complications
    - Instability
      - Bankart lesion
        Slap Lesion
        Fractures
- Dislocation = complete seperation of articulating surfaces
  - Subluxation
    - Partial seperation
·
- Rotator cuff tears/strains
  - important for eccentric control
    - poor muscle imbalance: internal vs external rot.
      - common older as tendon degen.
        Poor rehab =
        weakness
        Instability
        Impingement
        Tendinitis
  - Features
    - sudden onset of pain
      - Decrease ROM due to pain
        Awake from sleep - cant lie affected side
        Painful arc - 60-120
  - Treatment
    - Reduce pain and swelling
      - Increase scapular stabililty
        increase strength and flexibiity rotator cuff
        Restore joint stabliity
        get scap strong
      - Ice, soft tissue, electro
- - - Subacromial impingement
      - space is narrowed between
        above
        acormion
        coracomial arch
        A/C joint
        below
        glenohumeral joit
        overuse problem
        usually overhead sports
        can cause mechanical irritation of rot. cuff tendons.
        Mainly supraspinatus irritation
        supraspinatus tendinitis/ swimmers shoulder
        features
        pain on palpn. - local tenderness
        active abduction - painful arc
        70 - 120
        resisted abduction
        full empty can test
        abnormal scap rhythm
        treatment
        address cause impingement = instability
        treat symptoms
        ice
        electrotherapy
        soft tissue
        symptoms persist until stability imp.
        initial management
        inflammation control
        reduce/cease activity
        soft tissue: tv frictions tendons/general shoulder massage
        Later
        biomechanical correction
        scapular control/cuff weakness and imbalance
        address instability/scapulohumeral rhythm
      - Predisposing factors
        glenohumeral instability/ laxity
        previous injury
        tear/strain/ r. cuff overuse
        muscle weakness
        rot. cuff and poor scap control
        muscle imbalance
        int. vs ext. rotators - cuff vs delts
        abnormal scapular humeral rhythm
        Vicious circle
        inflammation
        swelling
        pain
        impaired function
        further narrowing of space: tendinitis, degeneration
        active/passive stabilisers
    - - scap stabalising exercises
        mainly prone best recruit scap stabliisers
        ensure scap is retracted and depressed
        can palp. traps make sure no compensation
        rowing in prone
        prone extension
        prone horizontal abduction
        superman
        TYI exercises
        progress from plank - kneel - pressup
        progress to walk outs or gym ball
        ROM
        pendulum
        passive - mobes
        active assisted
        pulley
        glide along table
        lying sleeper - rotate arm down
        internal/external rot
        by hip, abducted
        abduction
        lecture
        pendulum
        abd, flex, ext.
        45 then 90 abd
        internal/ext. rot.
        pendulum with weight
        intermediate
        lat, front, post. raise weighted/thera
        horizontal abd and add at 90 resistance
        diff angles for add/abd theraband
        IR/ER while holding wieght - bag, beans tennis ball, tband
        once able use dumbel
        ROM full - abd to top, IR/ER touch back
        can progress passively with rope or stick
        press up positioning isometric
        late stage
        WB
        neutral, inc, decl
        tricep dip
        shoulder strength below 90 abd
        lat raise
        front raise
        horixontal abd/add
        shoulder strength above 90
        medball press
        medball pass
        shoulder press
        front raise
        military press
        chest strength 1
        dumbell fly
        dumbell press
        can do incline
        chest 2
        incline bench
        bench press
        soulder strength 3
        y,t,w wih weight
        body weight dips
        late stage
        upper extremity resistance training
        functional
        olympic lifting
        dynamic
        aggressive
        sport specific
        gross body movements
        position specific
        weight =
        bean bag, bottle water, tband
        early
        scap strengthening prior rehab
      - rotator cuff strength
        progress from iso, concentric, eccentric and plyo
        early exrcises laying supine to maintain scap stabilisation
        therabands or weights
        improve ROM but below 90 initially
      - decrease pain must
        ensure doesn't alter mechanics from pain inhibition
Instability
- inadequet active stabliisers
  - muscles
  - And/or passive stabilisers (static)
    - glenohumeral ligaments
      - Labrum
- - can be due to dislo/sublux - TUBS, Bankart, SLAP
    - Atraumatic (non traumatic)/congenital (at birth)
      - Acquired Atraumatic
        results of overuse
        continued excess load on static + dynamic stablisers
        Repetitive microtauma
  - - Presentaion instability
      - Pain overhead activities
        particularly abd. + lat. rot.
        Possible 'dead arm syndrome"
        neural - brachial plexus irritation
        clicking/ popping. feeling instability
        scapular + rotator cuff weakness
        Development of impingement
        tests to confirm
        Sulcus sign, load and shift
        rot cuff = fail to depress the humeral head
        'silent subluxation'
        recurrent translation humeral head
    - - Treatment
        find balance of mobility and stability
        possible surgery for bankart repair
        can conservative repair
        try first 6-8 weeks
        initial
        scapular control:
        stabalising
        positioning
        movement
        Later
        rotator cuff
        function and strength
        glenohumeral mobility, strength and proprioception
        functional patterns
        sport specific integration
        if unsuccesful surgery
        Atraumatic (AMBR)
        respond well to rehab
        Traumatic (TUBS)
        usually require surgery to regain stability
- - Atraumatic instability
    - AMBR lesions
      - normally from repetitive stress
        of passive stablising structures - inf. GHJ lig. + capsule
        Common in overhead sports - swimming, throwing, racket sports
        A - atraumatic in origin
        M - Multidirectional instability accompanied by
        B - Bilateral instability
        R - Rehabilitation restores stability
  - Traumatic TUBS lesions
    - Due to dislo/sublux
      - Traumatic event giving rise to
        Unidirectional instability with a
        Bankart lesion and
        Surgery usually required
    - INSTABILITY
Laxity
- Assymptomatic
  - Paasive translation of humeral head on glenoid
    - Unnassociated with pain
- Instability
  - Painful
    - associated with excessive translation of humeral head
      - on glenoid fossa in active movements

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Description: Mind Map on shoulder, created by Glen Chesterton on 07/05/2017.
Created by: Glen Chesterton
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