2. Sternoclavicular Joint Sprain
• Mechanism
– Force applied to lateral aspect of shoulder
(travels medially through clavicle)
– Force applied anterior or posterior to shoulder
– Stretching of SC ligament from direct or
indirect force to joint
– Rare-traction force (i.e. uneven bars)
3. • Signs and symptoms
– Point tenderness over SC joint
– Pain with active/passive stretch
– Loss of function
– Pain with protraction/retraction
– Dislocations tend to occur anterior or superior
• Although posterior can occur and is a medical
emergency
5. • Special Tests
– Active and resistive movements
– Passive stress
• Diagnostic Procedure
– Refer to ortho
– X-Ray
*If posterior emergent
6. Acromioclavicular Joint Sprain
• Mechanisms
– Downward force on point of shoulder with arm
adducted
• Blow to acromion process which drives scapula
inferior
– Stretching of AC ligament due to direct or
indirect force applied to joint
7. AC Classification System
• I
– Slight partial damage to AC ligament, negative laxity,
point tenderness
• II
– Rupture AC and partial CC, slight laxity
• III
– Complete AC and CC, dislocation distal
clavicle/acromion
• IV, V, VI
– AC/CC/tearing deltoid/trap fascia
8. • Signs and Symptoms
– Pain on A/P/RROM
– Loss of function
– Tenderness over AC joint
– Swelling
– Hemorrhage
– Ecchymosis
– Inflammation
– Step deformity
9. • Signs and Symptoms (cont)
– Pain on shoulder abduction
– Pain on distraction of AC joint
– Abnormal motion of distal clavicle
– Deformity
– Instability (2nd
and 3rd
degree)
10. • Special Tests
– Distraction (piano key)
– AC Traction/Compression
– Pain on Abduction
– A/R ROM
– Apley’s scratch test
• Diagnostic Procedure
– Ortho
– X-Ray
16. • Special Tests
– Check pulse at wrist
– Check sensation of arm/hand
• Diagnostic Procedure
– Refer to ortho
– X-Ray
17. Glenohumeral Instability
• Result of ligamentous or labral pathology
• Grade of severity is based on joint glide
movements
• GH instability has a close relationship with
pathological changes in RC
21. Glenoid Labrum tear
• Mechanism
– Repetition of shoulder motion
– Acute Trauma
– Ant. Subluxation of glenohumeral jt.
22. • Special tests
– Clunk test
– Resistive ROM
– Apprehension test
• Diagnostic
– Ortho
– MRI
23. • Signs and symptoms
– Pain
– Loss of smooth shoulder motion
– Pop or snap on extended rotation
– Pain with ER at 90 deg of abduction
– Possible positive clunk test
– Pain with forced abduction
– Pain on forced horizontal adduction
– Weakness of RC
24. Anterior Glenohumeral
Subluxation
• Mechanism
– Leverage force applied to an abducted and ER
arm
• Signs and Symptoms
– Pain
– Loss of function
– Sensation of shoulder slipping out of place
25. • Signs and Symptoms (continued)
– Obvious deformity before reduction
– Spasm
– Positive apprehension test
– Head of humerus is palpable while slipping
forward
26. • Special Tests
– Apprehension test
– Relocation test
– Sulcus sign
– Glenohumeral translation
– Clunk test
• Diagnostic Procedure
– Refer to ortho
27. Bankhart Lesion
• Inferior GH ligament may be avulsed along
with a portion of the labrum
• Complains of pain/crepitus as humeral head
moves against anterior labrum during GH
glide testing
28. Hills-Sach Lesion
• Common finding associated with anterior
GH dislocation
• Small defect in posterior humeral head’s
articular cartilage
• Caused by impact of humeral head on
glenoid fossa as humerus attempts to
relocate
29. Superior Labrum Anteroposterior
Lesions
• Known as SLAP lesions
• Tear in superior glenoid labrum located
near the attachment of the long head of
biceps brachii tendon
30. Rotator Cuff Impingement
• Mechanisms
– Decreased space in subacromial arch
– Structures beneath are impinged between
acromion and humeral head
• Chronic microtrauma
• Vascular impairment
• Partial tear RC- altered mechanics
• Anatomic variation of arch
31. • Signs and Symptoms
– Increase in pain from IR to ER
– Snapping sensation
– Loss of function
– Pain with overhead activity
– Painful arc
– Pain on superolateral aspect of shoulder
32. • Signs and Symptoms (cont.)
– Pain on active abduction between 70 and 130
degree
– Pain on extreme forward flexion with forearm
supinated
– Pain on internal rotation with arm abducted at
90 and forearm pronated
33. • Special tests
– Impingement test (Neer and Hawkins)
– Forward Flexion test
– Empty can test
– RROM
• Diagnostic Procedure
– Ortho
34. Rotator Cuff Tendinitis/Strain
• Mechanisms
– Trauma due to excessive forcible contraction or
stretching
– Muscle fatigue
– Overuse
– Slow onset
– Decrease muscle balance between IR and ER
– Capsular laxity
– Poor vascularization of tendons
– Supraspinatus most commonly injured
35. • Symptoms and Signs
– Pain with A/P/RROM
– Loss of function
– Snapping
– Tenderness
– Spasm
– Swelling
– Ecchymosis
36. • Signs and Symptoms
– Pt. Tenderness over RC tendons
– Inflammation
– Hematoma formation
– Muscle defect
– Pain on abduction/ER/ and flexion of shoulder
37. • Special Test
– Apley’s scratch
– Impingement
– Drop Arm
– Forward Flexion
– Empty can
*Refer to Ortho
38. Tenosynovitis of Shoulder
• Mechanism
– Overuse
– Direct or repeated trauma
– Poor throwing techniques
• Signs and symptoms
– Pain on A/P/RROM
– Loss of function
– Tenderness
– Swelling
– Thickening of tendon
40. Bicep Tendon Pathology
• Biceps Tendinitis
• Luxation of bicep tendon
• Long Head of biceps rupture
41. Bicep tendinitis
• Mechanism
– Irritation of biceps tendon in the groove
– Rotator cuff dysfunction
– Repeated microtrauma
– Overuse
– Degenerative changes
– impingement
42. • Signs and symptoms
– Pain on P/A/RROM
– Loss of function
– Overuse activity
– Tenderness
– Errythema
– Swelling
– Inflammation
– Crepitus
43. • Special Tests
– A/P/RROM
– RC muscle test
• Diagnostic Procedure
– Physician if symptoms persist
44. Luxation of biceps tendon
• Mechanism
– Inadequate muscle development
– Overuse in throwing
– Tearing of transverse humeral ligament
– Shallow bicipital groove of humerus
– Faulty mechanics
45. • Signs and Symptoms
– Pain in anterior aspect of shoulder
– Loss of shoulder function
– Snapping sensation followed by dull ache in
arm or arm feeling dead
– Tenderness over bicipital groove
– Inflammation
46. • Special Tests
– Yergason
– Speed’s
– Ludington
• Diagnostic Procedure
– Refer to physician
47. Long head of biceps rupture
• Mechanism
– Violent contraction against resistance
• Symptoms/signs
– Pain
– Loss of function
– Sensation of something rolling up arm
– Protruding bulge in biceps
– Tenderness along long head
– Loss of strength
48. • Special Tests
– Ludington’s test
• Diagnostic Procedure
– Refer to ortho
49. • Contusion of biceps
– Mechanism
• Direct Trauma
– Signs and Symptoms
• Pain
• Loss of elbow flexion and extension
• Transitory paralysis
• Pt. Tenderness
• Ecchymosis
• Hematoma Formation
• Inflammation
50. • Special Tests
– A/P/RROM
• Diagnostic Procedures
– Refer if symptoms persist
54. Humerus Fracture
• Mechanism
– Direct trauma
– Fall on an outstretched arm
• Signs and Symptoms
– Sudden pain
– Loss of function
– Tenderness
– Deformity
– Rapid Swelling
55. Axillary N. Injury
• Mechanism
– Direct trauma to lateral arm
– 2nd
to anterior dislocated arm
• Signs and symptoms
– Loss of shoulder abduction
– Tenderness
– Loss of function of deltoid/biceps
– Dermatome numbness in area of middle Deltoid
56. • Special Tests
– A/RROM for Deltoid
– Sensation testing for Deltoid
• Diagnostic Procedures
– Neurologist
58. • Signs and Symptoms
– Similar to RC impingement
– Pain(at night/ ache with rest)
– Loss of function
– Tenderness
– Redness, swelling, inflammation
– Pain on rotation and/or abduction>80 deg
59. • Special Tests
– Appley’s Scratch test
– Resistive movements
• Diagnostic
– Refer to physician
61. • Signs and Symptoms
– Pain
– Loss of function
– Tenderness(under deltoid)
– Redness, swelling, inflammation
– Pain and/or weakness on abduction
62. • Special Tests
– Apley’s scratch test
– Resistive movement tests
• Diagnostic
– Refer to physician
63. Clavicle Contusion
• Mechanisms
– Direct trauma to clavicle
• Symptoms
– Pain
– Loss of Function
– Transitory paralysis
– Point tenderness
– Inflammation
64. • Special Tests
– Distraction Test (rule out AC sprain)
• Diagnostic Procedure
– Refer to orthopedic surgeon
– XRay
65. Deltoid Contusion
• Mechanism
– Direct Trauma
• Symptoms
– Pain
– Loss of function
– Point tenderness
– Transitory paralysis
– Weakness on shoulder abduction
66. Long Thoracic N. Contusion
(Winging Scapula)
Mechanism
– Indirect trauma to lat. Thoracic wall or shoulder
– Overuse of shoulder
– Prolonged traction (i.e. cycling)
Signs and symptoms
– Scapular winging (scapula protrudes posteriorly)
– Dull ache around shoulder girdle
– Decrease motion with shoulder movement
67. • Special Tests
– Scapula protraction test
• Pushing against a wall will cause winging effect
• Diagnostic Procedure
– Physician
– EMG study (Electromyography)
68. Thoracic Outlet Syndrome
• Mechanism
– Pressure on medial cord of brachial plexus,
subclavian artery a/o subclavian vein
(neurmuscular bundle)
– Cervical rib
– Pect minor/scalene tightness
– Pressure on neurovascular bundle as it runs
between clavicle and first rib
69. Signs and Symptoms
• Neurological
– C8-T1 medial because of closeness to 1t rib,
ulnar n, occasionally median n.
• Vascular
– Vein-swelling
– Artery-decreased blood flow
72. • Signs and Symptoms
– Sudden pain
– Tenderness(direct /indirect)
– Loss of shoulder function
– Deformity(rapid swelling/bony deviation)
– Head tilt towards side of fracture
– Crepitus
73. • Signs and symptoms (cont.)
– False joint motion
– Delayed ecchymosis
– Head tilted toward side of fracture
– Rounded shoulder
– Athlete may be supporting affected elbow with
opposite hand
*Refer to ortho/X-ray
74. Scapula Fracture
• Mechanism
– Direct trauma
– Indirect trauma from fall (on shoulder or arm)
• Signs and Symptoms
– Sudden pain
– Loss of function
– Tenderness (direct/indirect)
– Possible crepitus
76. Proximal humerus Epiphyseal
plate Injury
• Mechanisms
– Direct trauma
– Indirect along shaft
• Signs and symptoms
– Pain
– Loss of function
– Deformity
– Swelling
– Crepitus
– False joint
77. Blocker’s Extosis
• Myositis Ossificans
• Mechanisms
– Repetitive trauma to humerus
• Signs and symptoms
– Pain
– Pt. Tenderness
– Bony prominence
– Swelling
– Loss of function-elbow flexion/extension
78. Humerus Fracture
• Mechanism
– Direct trauma from fall/external force
• Signs and Symptoms
– Pain
– Loss of function
– Deformity- shortened humerus
– Swelling
– False joint motion
79. Triceps strain
• Mechanism
– Excessive forcible contraction or stretching
– Muscle fatigue
• Signs and symptoms
• Tests
