2. Clavicle Fx MOI: FOOSH, Fall on tip of shoulder, direct contact S&S: guarding, obvious deformity, swelling, point tenderness

3. Clavicle Fx Plan: refer for x-rays, sling and swathe, treat for shock, possible surgery Follow up: immobilize 6-8 weeks

4. Acromioclavicular Sprain MOI: direct contact to tip of shoulder or FOOSH

5. Acromioclavicular Sprain S&S: Grade 1-point tenderness, discomfort during movement Grade 2-partial displacement, acromial end of clavicle sticks up, ttp, unable to fully abduct, AC stress test positive

6. Acromioclavicular Sprain S&S: Grade 3 – complete rupture of the AC and CC ligaments, displacement, limited abduction Grade 4 – posterior dislocation of clavicle, point tenderness, limited ROM

7. Acromioclavicular Sprain S&S: Grade 5 – Muscle and ligament ruptures, gross deformity, severe pain, loss of movement, shoulder instability Grade 6 – clavicle displaced inferior to the coracoid, rare in sports

8. Acromioclavicular Sprain Plan: 1. Cold and pressure 2. Sling and Swathe 3. Refer to doctor

9. GH Dislocations Anterior Posterior

10. GH Dislocations Extensive damage to the shoulder complex occurs.

11. Anterior Dislocation MOI: Direct contact to posterior shoulder Forced abduction, external rotation, and extension

12. Anterior Dislocations S&S 1. Flattened deltoid contour 2. Guarding – slight abduction and external rotation 3. Humeral head palpated in the axilla(armpit) 4. Unable to touch opposite shoulder 5. Moderate pain 6. Disability

13. Posterior GH Dislocation MOI: Forced adduction and internal rotation Fall on extended and internally rotated arm

14. Posterior GH Dislocations S&S: 1. Severe pain and disability 2. Guarding – adduction and internal rotation 3. Acromion and coracoid stick out 4. Head of humerus visible posterior 5. Limited external rotation and elevation

15. GH Dislocation - Plan Immobilization Ice X-ray if first dislocation Reduce shoulder Ice Immobilization

16. GH Dislocation - Plan Rehab Internal and External rotation are IMPORTANT Start with isometrics then add resistance Bracing for play

17. Impingement Syndrome MOI: repetitive overhead stress Examples: Swimming Serving a tennis ball Hitting volleyball (spike) Throwing (baseball, track, football)

18. Impingement Syndrome S&S: 1. Diffuse pain around acromion 2. Pain with overhead activities 3. E.R. weaker than I.R. 4. Positive impingement tests 5. Empty can and drop test increase pain.

19. Impingement Syndrome Plan: 1. Restoring normal biomechanics 2. Strengthen rotator cuff 3. Strengthen core 4. Joint Mobilizations 5. RICE and e-stim 6. Modify activity

20. Severe Impingement Plan: Immobilization and complete rest. Potentially need surgical intervention

21. Thoracic Outlet – Basics Compression of the brachial plexus, subclavian artery and vein

22. Thoracic Outlet Syndrome MOI: 1. Narrowing between 1 st rib and clavicle 2. Anterior and middle scalene muscles 3. Pectoralis minor compressing 4. Presence of a cervical rib

23. Thoracic Outlet Syndrome S&S: Paresthesia Pain Feeling cold Muscle weakness Muscle atrophy Radial nerve palsy Poor circulation in hand

24. Thoracic Outlet Syndrome Special Tests: 1. Wright’s Test or Hyperabduction test 2. Eden’s Test 3. Roo’s Test 4. Adson’s Test

25. Thoracic Outlet Syndrome Plan: Correcting the MOI with stretching & strengthening 1. Stretching Pectoralis minor Scalenes

26. TOS - Plan Strengthening Trapezius Rhomboids Serratus Anterior

27. TOS - Plan Strengthening Trapezius Rhomboids Serratus Anterior

28. Strengthening Trapezius Rhomboids Serratus Anterior

29. Brachial Plexus Neuropraxia Also called a stinger or burner. MOI: direct contact or hyper- horizontal abduction

30. Brachial Plexus Neuroplaxia S&S: Numbness and tingling down through hand Pain shooting to hand Inability to move hand Pain in shoulder

31. Plan: Have athlete move their arm. Give them about 15 minutes to recover. If they don’t recover, send to hospital. Brachial Plexus Neuroplaxia

32. Biceps Brachii Ruptures MOI: Powerful eccentric or concentric contraction of the muscle Can rupture at long head or insertion “Popeye” effect

33. Biceps Brachii Rupture S&S: SNAP Sudden, intense pain Popeye effect Weakness of the biceps

34. Biceps Brachii Rupture Plan: Cold Sling Refer to physician Usually surgery