Sports med 2

A“Type of pain”  pins and needles = radiating pain from cervical pathology  sharp pain = acute inflammation  dull, aching, sense of heaviness = chronic rotator cuff  deep, aching pain in the neck/shoulder region = TOCS  night pain = rotator cuff tear  burning pain = acute tendinitis  weakness, numbness = nerve pathology

B“specific movements that cause pain”  neck = cervical spine injury  shoulder ER = dislocation/subluxation  above 90 degrees = ACJ

 Normal activities  Ability to talk/swallow = SCJ  Which hand is dominant  shoulder often lower  differing ROM  differing strength

From all sides  symmetry level of shoulders  muscle wasting v. hypertrophy  deformities  discoloration  swelling  how the shoulder is carried

Anteriorly  Step deformity at the ACJ = dislocation  Flat deltoid = anterior dislocation

Laterally  kyphosis: shoulders slumped forwards

Posteriorly  muscle definition  scapulohumeral rhythm  scapular winging during flexion and abduction

Anterior structures  clavicle  sternoclavicular joint  sternocleidomastoid muscle  acromioclavicular joint  trapezius  deltoid  coracoid process  sternum  ribs and costal cartilage  humerus and rotator cuff muscle  with thumb on subscapularis, second, third and fourth fingers will be over the insertion of other three rotator cuff muscles: supraspinatus, infraspinatus, teres minor  axilla  posterior wall = lats  anterior wall = pec major  medial wall = serratus anterior

Posterior structures  scapula  spine of scapula  medial border of the scapula  inferior angle  lateral border  supraspinatus and infraspinatus muscles

 abduction  note painful arc (45 – 60 – 100 degrees)  observe scapulohumeral rhythm  first 30 degrees no net movement of the scapula setting  degress scapula abducts and upwardly rotates 1 degree for each 2 degree of humeral elevation  90 – 180 degrees scapula moves 1 degree for each 1 degree of humeral elevation  observe any apprehension  flexion  ER  IR  Extension  Adduction  Horizontal adduction/abduction  Circumduction  Appley’s scratch test Sort of!