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

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

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

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

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

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

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

GH Dislocations Anterior Posterior

GH Dislocations Extensive damage to the shoulder complex occurs.

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

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

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

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

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

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

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

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.

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

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

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

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

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

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

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

TOS - Plan Strengthening Trapezius Rhomboids Serratus Anterior

TOS - Plan Strengthening Trapezius Rhomboids Serratus Anterior

Strengthening Trapezius Rhomboids Serratus Anterior

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

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

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

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

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

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