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HOPS
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Palpation – deformity, temperature, pain, density
History Past Not necessarily Mechanism Fall or blow Pain Very specific spot 8-10 Sharp Changes Nothing helps Movement painful Sounds/ Sensations Felt a pop Observation Swelling Positioning Facial Expressions Discoloration Palpation – deformity, temperature, pain, density Bone Humerus Greater and Lesser tuberosity Clavicle Acromion Coracoid Ulna/ Radius (forearm bones)
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Palpation (cont) Special Tests Treatment Muscles Soft Tissue
Bicep Tricep Deltoid Rotator Cuff tendons Latissimus Dorsi Soft Tissue Acromio-Clavicular Ligament Coraco-Clavicular Ligament Special Tests Fracture +Pain Bump Lever Compression Treatment Sling Ice Refer to Dr. for x-rays
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Humerus Fracture
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Palpation – deformity, temperature, pain, density
History Past Not necessarily Mechanism Fall or blow Pain Very specific spot 8-10 Sharp Changes Nothing helps Movement painful Sounds/ Sensations Felt a pop Observation Swelling Deformity Positioning Facial Expressions Discoloration Palpation – deformity, temperature, pain, density Bone Humerus Greater and Lesser tuberosity Clavicle Acromion Coracoid
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Palpation (cont) Special Tests Treatment Muscles Soft Tissue
Deltoid Trapezius Pec major Soft Tissue Acromio-Clavicular Lig Coraco-clavicular lig Special Tests Fracture +Pain Bump Lever Compression Treatment Sling Ice Refer to Dr. for x-rays
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Clavicle Fracture
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Palpation – deformity, temperature, pain, density
History Past Not necessarily Mechanism Fall or blow Pain Over the AC joint 5-8 Changes Ice helps Movement painful Sounds/ Sensations Felt a pop (maybe) Observation Positioning/ Carrying angle Palpation – deformity, temperature, pain, density Bone Humerus Greater and Lesser tuberosity Clavicle Acromion Coracoid Muscles Deltoid Trapezius Pec major
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Special Tests Palpation (cont) Special Tests
Range of Motion +Pain, Decreased Motion Active Flexion, Extension, Abduction, Elevation, Depression Passive Flexion past 90, Abduction past 90 Extension at end range Resistive N/A Palpation (cont) Soft Tissue Acromio-Clavicular Lig Coraco-clavicular lig Special Tests Fracture +Pain Bump Lever Compression
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Special Tests (cont) Treatment O’Brian’s Sling Ice
Flex, adduct, rotate humerus + pain at AC Acromio-Clavicular Instability Move clavicle in 3 directions (up, down, in) + pain w/ mvmt, laxity Treatment Sling Ice Refer to Dr. for x-rays to rule out fx.
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Grade 1 Acromio-Clavicular Sprain
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Grade 4 Acromio-Clavicular Sprain
Observation Positioning/ Carrying angle Deformity Facial Expression Palpation – deformity, temperature, pain, density Bone Humerus Greater and Lesser tuberosity Clavicle Acromion Coracoid Muscles Deltoid Trapezius Pec major History Past Not necessarily Mechanism Fall or blow Pain Over the AC joint 5-8 Changes Ice helps Movement painful Sounds/ Sensations Felt a pop
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G4 AC Palpation (cont) Special Tests Special Tests Treatment
Soft Tissue Acromio-Clavicular Lig Coraco-clavicular lig Special Tests Fracture +Pain Bump Lever Compression Special Tests Due to obvious visual and palpation deformity, no special tests need to be done Treatment Sling Ice Refer to Dr.
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Gleno-humeral Sprain History Observation Past
Positioning/ Carrying angle Facial Expression Palpation – deformity, temperature, pain, density Bone Humerus Greater and Lesser tuberosity Clavicle Acromion Coracoid Muscles Deltoid Trapezius Pec major History Past Not necessarily Mechanism Fall or blow Pain Gleno-humeral joint 5-8 Changes Ice helps Movement painful Sounds/ Sensations Felt a pop
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Gleno-humeral Sprain Palpation (cont) Special Tests
Soft Tissue GH ligament CC ligament Special Tests 1. Fracture (+pain) Bump, Lever, Compression 3. Anterior Drawer (+pain and laxity) Pull head of the humerus forward 4. Sulcus Sign (+pain and laxity) Pull humerus down 2. Range of Motion +Pain, Decreased Motion Active Flexion, Extension, Abduction, Elevation, Depression Internal Rotation External Rotation Passive Flexion past 90, Abduction past 90 Extension at end range Rotation at end range Resistive N/A
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Gleno-humeral Sprain Treatment Immediate Long Term
RICE for hours; sling Long Term Cryotherapy (cold), ultrasound massage passive and active exercise to regain full ROM When full ROM achieved w/out pain, resistance exercises can be initiated
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Subluxation Observation History
Positioning/ Carrying angle Holding into internal rotation Facial Expressions Possible Swelling Palpation – deformity, pain, temperature, density Bone Humerus Greater and Lesser tuberosity Clavicle Acromion Coracoid Muscles Deltoid Trapezius Pec major Biceps History Past Not necessarily Mechanism Fall Blow Overstretch Pain General shoulder 5-8 Changes Ice helps Movement painful Sounds/ Sensations Felt a loud pop
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Subluxation Palpation (cont) Special Tests
Soft Tissue GH ligament CC ligament Special Tests 1. Fracture (+pain) Bump, Lever, Compression 3. Apprehension and Relocation Abduct to 90 while supine, then internally and externally rotate +pain without pressure, no pain with pressure 2. Range of Motion +Pain, Decreased Motion Active Flexion, Extension, Abduction, Elevation, Depression Internal Rotation External Rotation Passive Flexion past 90, Abduction past 90 Extension at end range Rotation at end range Resistive N/A
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Subluxation Treatment Rest Ice Compression
Sling Ice Compression ACE wrap Refer to Dr. to rule out other injuries
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