Injuries to the Shoulder Anatomy Injuries Special Tests

Shoulder Anatomy Review.. * Head of the humerus – Upper portion of the humerus, where the bone attaches to the scapula. * Glenoid Fossa – a slightly concave projection of the scapula * Glenohumeral (GH) joint – the synovial ball-and-socket joint of the shoulder * Acromion process – lateral projection of the spine of the scapula that forms the point of the shoulder and articulates with the clavicle * Acromioclavicular joint – joint formed by the acromion of scapula and the clavicle * Sternoclavicular joint – area where the sternum and clavicle connect * Scapulothoracic joint – area that provides movement of the scapula over the back side of the ribcage

Shoulder Anatomy

Rotator Cuff * Collective set of four deep muscles of the glenohumeral joint; critical for shoulder movement; commonly involved in shoulder injuries *All four muscles arise from the scapula and insert on the superior aspect of the humerus, wrapping the head of the humerus. Supraspinatus – inserts onto the humerus anterosuperiorly Infraspinatus – inserts onto the humerus posterosuperiorly Teres minor – inserts onto the humerus posteriorly Subscapularis – inserts onto the humerus anteriorly

Rotator CUff

Shoulder INjuries ~ A good percentage of shoulder injuries are considered OVERUSE injuries. ~Usually due to Poor posture at rest Muscular imbalance during exercise

Overuse INjuries Impingement Syndrome Bicep Tendonitis

Impingement Syndrome Basic Info: space between humeral head and acromion becomes narrowed; bones then squeeze or “impinge” the structures that occupy the space S/S: pain/tenderness in GH area; pain/weakness with active abduction; limited internal rotation; tenderness to palpation in subacromial area Tx: mechanics and postural evaluation; referral to PT Rehab/RTP: LOTS of stretching, postural corrections, progressive strengthening of rotator cuff muscles. RTP decided by physical therapist and/or Dr.

Special Tests: Neer’s Impingement Test Patient position: sitting or standing Examiner position: standing on involved side, one hand stabilizing scapula, other hand holding pt’s wrist Action: internally rotate humerus; move GH joint through flexion (don’t allow scapular movement) +: pain in anterior or lateral shoulder from 90 to full flexion = rotator cuff impingement (supraspinatus) Notes: none

Special Tests: Hawkins-Kennedy Patient position: sitting or standing Examiner position: standing on involved side, holding pt’s arm at elbow jt. Action: flex elbow to 90, lift arm to shoulder height in scapular plane; internally rotate humerus +: pain, especially at end ROM = rotator cuff pathology (supraspinatus) Notes: don’t allow humeral movement toward midline during test = false positive.

Special Tests: Empty Can Test Patient position: standing, arms abducted to 90 and at 45 angle in front (“V”) Examiner position: standing facing the patient Action: active internal rotation of humerus; examiner applies downward pressure against patient resistance +: pain and/or weakness (unable to maintain abduction) = rotator cuff pathology (supraspinatus) Notes: if concern is of supraspinatus TEAR, don’t internally rotate (Full Can)

Bicep Tendonitis Basic info – tendon inflammation where bicep connects to the shoulder S/S – pain/tenderness in anterior shoulder, especially with palpation during internal and external rotation Tx – rest; mechanical/postural corrections Rehab/RTP – will involve LOTS of stretching to anterior shoulder and bicep; RTP – once symptoms resolve; determined by physical therapist and/or Dr.

Special Tests: Yergason’s Test Patient position: sitting or standing, elbow flexed to 90, palm up Examiner position: standing lateral and JUST behind patient; one hand on superior shoulder; other hand holding wrist Action: resist active elbow flexion while moving GH joint into external rotation +: pain or ‘snapping’ in bicipital groove = bicep tendonitis or incomplete tear Notes: none

Rotator Cuff INjury Basic info – can be acute (tear) or chronic; partial (do not completely sever the tendon) or full-thickness S/S – pain, “catching,” weakness; partial = pain, but full/normal ROM; full-thickness = unable to perform AROM overhead Tx – ice, NSAIDs, referral to Dr.; partial = rehab; full-thickness = surgical repair Rehab/RTP – will depend on surgical v non-surgical; rehab will focus on functional strengthening and postural/mechanical corrections; RTP will be decided by combo of PT and referring Dr.

Special Tests: Drop Arm Test Patient position: sitting or standing, with arm completely overhead Examiner position: standing in proximity to the patient/athlete Action: athlete actively lowers the arm to the side (adduction) +: weakness through mid-range of adduction (arm will drop once it approaches 100-90 degrees of adduction. Notes: Use caution in having athlete raise arm overhead to start test – if this motion causes significant pain, do not proceed with test.

Acute INjuries Bicep Tendon Rupture GH Dislocation AC Separation Fractures Acute INjuries

Bicep Tendon Rupture Basic info: long head of the bicep tendon tears at proximal end; more common in weightlifting than athletics S/S: ecchymosis in upper, anterior arm; inability to flex elbow, severe pain Tx: complete rest for a period of time (while tendon heals); ice and probable immobilization; referral to physician/surgeon Rehab/RTP: slowly progressive strengthening; if surgical, clearance needs to be from surgeon and Dr. If not, Dr. can release to athletics with physical therapist advice.

SPEED’s Test Patient Position: standing or sitting; shoulder flexed to 90, supinated. Examiner Position: standing lateral to patient Action: resist active shoulder flexion (apply downward pressure) +: pain or weakness in bicipital groove; or patient unable to maintain flexion Notes: if patient cannot perform flexion to 90, DO NOT attempt to apply resistance!

GH Dislocation Basic info: head of humerus falls completely off glenoid fossa; 3 types – anterior/inferior (most common), inferior, posterior; can also result in glenoid labrum tear. S/S: severe pain; deformity (Sulcus sign), potential for neurological symptoms into involved arm Tx: immediate referral to physician, immobilization, further evaluation to determine need for surgery Rehab/RTP: extremely slow progression, but becomes aggressive strengthening to avoid recurring injuries

Jerk Test Patient Position: supine, at lateral edge of table, abducted to 90 and elbow flexed to 90 Examiner Position: standing lateral to patient’s shoulder, one hand stabilizing scapula, other hand on outer point of elbow Action: apply axial load to elbow; then passively (horizontally) adduct while maintaining axial load +: “Clunk” noise that may or may not be painful = GH instability and/or glenoid labrum tear Notes: DO NOT PERFORM TEST IF SUBLUXED OR DISLOCATED!!!

AC Separation Basic info: traumatic sprain to the AC joint, MOI is usually direct contact/trauma to tip of shoulder; classified in degrees (1st, 2nd, 3rd) S/S: pain surrounding the AC joint, deformity (clavicle will appear elevated in complete separation (picture on the next slide) Tx: remove from play; ice; referral to physician; additional treatment varied depending on degree Rehab/RTP: ROM and light strengthening exercises will begin rehab

AC Separation Grading

O’Brien’s Test (Active Compression Test) Patient Position: standing, shoulder flexed to 90, very slightly adducted Examiner Position: in front of patient, one hand over posterior aspect of distal forearm Action: patient resists downward force exerted by examiner +: pain over AC joint = AC sprain/separation Notes: none

Fractures Basic info: S/S: Tx: Rehab/RTP: