1. Shoulder Injuries

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

4. Signs and Symptoms (cont.)
Inflammation
Hemorrhage
Ecchymosis
Deformity
Instability (with 2nd,3rd degree)

5. Special Tests Diagnostic Procedure 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
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 Diagnostic Procedure Distraction (piano key)
AC Traction/Compression
Pain on Abduction
A/R ROM
Apley’s scratch test
Diagnostic Procedure
Ortho
X-Ray

11. Subcoracoid glenohumeral luxation(dislocation)
Mechanism
Force applied to an abducted, ER arm above 90 deg
Signs and symptoms
Pain
Loss of function
Deformity
Swelling
Tenderness on anterior aspect of shoulder

12. Special Tests Diagnostic Procedure Check pulse
Check sensation over axillary n.
Diagnostic Procedure
Refer to ortho
X-ray

13. Glenohumeral/subglenoid luxation(dislocation)
Mechanism
Force applied to an abducted arm
Signs and Symptoms
Pain
Loss of function
Marked deformity
Swelling
Pt. Tenderness
Flattened deltoid

14. Special Tests Diagnostic Procedure Check pulse at wrist
Check for sensory loss in arm and hand
Diagnostic Procedure
Refer to ortho
X-ray

15. Posterior Glenohumeral Luxation(dislocation)
Mechanism
Fall on outstretched arm
Blow to the front of the shoulder
Signs and Symptoms
Pain
Loss of function
Marked deformity
Swelling
Pt. Tenderness

16. Special Tests Diagnostic Procedure 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

18. Anterior Glenohumeral Instability
Mechanism
Acute
Repetitive microtrauma involving ER when GH joint is abducted to 90 degrees

19. Signs and symptoms Sensation of slipping out of place Increased laxity
Positive apprehension/relocation test
Increased anterior glide
Flattened deltoid
Diffuse pain
Tenderness to anterior GH joint
RC atrophy

20. Special Tests Positive Apprehension Positive relocation sign
Sulcus sign
Glenohumeral translation

21. Glenoid Labrum tear Mechanism Repetition of shoulder motion
Acute Trauma
Ant. Subluxation of glenohumeral jt.

22. Special tests Diagnostic Clunk test Resistive ROM Apprehension test
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 Diagnostic Procedure 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 Diagnostic Procedure 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

39. Special Tests
A/P/RROM
Diagnostic Procedure
Refer to ortho

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 Diagnostic Procedure A/P/RROM RC muscle test
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 Diagnostic Procedure Yergason Speed’s Ludington
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 Signs and Symptoms Direct Trauma Pain
Loss of elbow flexion and extension
Transitory paralysis
Pt. Tenderness
Ecchymosis
Hematoma Formation
Inflammation

50. Diagnostic Procedures
Special Tests
A/P/RROM
Diagnostic Procedures
Refer if symptoms persist

51. Exostosis/Myositis Ossificans
Mechanism
Repeated trauma (humerus)
Signs and Symptoms
Pain
Point tenderness
Possible paresthesia
Swelling
Loss of Function

52. Proximal Humerus Epiphyseal Plate Injury
Mechanism
Direct trauma
Indirect trauma traveling along length of humerus

53. Signs and Symptoms Sudden pain Tenderness Deformity Rapid Swelling
Possible bony deviations
Crepitus
Ecchymosis

54. Humerus Fracture Mechanism Signs and Symptoms Direct trauma
Fall on an outstretched arm
Signs and Symptoms
Sudden pain
Loss of function
Tenderness
Deformity
Rapid Swelling

55. Axillary N. Injury Mechanism Signs and symptoms
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. Diagnostic Procedures
Special Tests
A/RROM for Deltoid
Sensation testing for Deltoid
Diagnostic Procedures
Neurologist

57. Subacromion Bursitis Mechanism Direct Trauma Overuse
Fall on an outstretched hand
RC impingement (i.e. stress from throwing)

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 Diagnostic Appley’s Scratch test Resistive movements
Refer to physician

60. Subdeltoid bursitis Mechanism Direct Trauma Fall on outstretched hand
Overuse

61. Signs and Symptoms Pain Loss of function Tenderness(under deltoid)
Redness, swelling, inflammation
Pain and/or weakness on abduction

62. Special Tests Diagnostic Apley’s scratch test Resistive movement tests
Refer to physician

63. Clavicle Contusion Mechanisms Symptoms Direct trauma to clavicle Pain
Loss of Function
Transitory paralysis
Point tenderness
Inflammation

64. Special Tests Diagnostic Procedure
Distraction Test (rule out AC sprain)
Diagnostic Procedure
Refer to orthopedic surgeon
XRay

65. Deltoid Contusion Mechanism Symptoms Direct Trauma 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 Diagnostic Procedure Scapula protraction test Physician
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 Vascular
C8-T1 medial because of closeness to 1t rib, ulnar n, occasionally median n.
Vascular
Vein-swelling
Artery-decreased blood flow

70. Tests
Adson’s
Allen
Costoclavicular (military brace)

71. Clavicle Fracture Fracture collar bone Mechanisms
Fall on outstretched arm
Direct contact

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 Signs and Symptoms Direct trauma
Indirect trauma from fall (on shoulder or arm)
Signs and Symptoms
Sudden pain
Loss of function
Tenderness (direct/indirect)
Possible crepitus

75. Signs and Symptoms (cont.)
Rapid Swelling
Bony deviations
Crepitus
False Joint Motion
Delayed Ecchymosis
*Refer to ortho/X-Ray

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 Signs and symptoms
Repetitive trauma to humerus
Signs and symptoms
Pain
Pt. Tenderness
Bony prominence
Swelling
Loss of function-elbow flexion/extension

78. Humerus Fracture Mechanism Signs and Symptoms
Direct trauma from fall/external force
Signs and Symptoms
Pain
Loss of function
Deformity- shortened humerus
Swelling
False joint motion

79. Triceps strain Mechanism Signs and symptoms Tests
Excessive forcible contraction or stretching
Muscle fatigue
Signs and symptoms
Tests