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43 Cards in this Set
- Front
- Back
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Shoulder Sternoclavicular joint Acromioclavicular Glenohumeral
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Brachial Plexus |
C 5, 6, 7, 8, T 1, right beside the subclavian artery |
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Most critical muscles and joints of shoulder |
Scapula stabalizing muscles and the relationship between glenohumeral and the other joints of the shoulder |
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What is scalpohumeral rythm? How many degrees of movement is it? |
Movement of the scapula relative to the humerus
Initial 30 degrees of glenohumeral abduction does not incorporate scapular motion |
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Ratios of scapular motion: |
0 - 30 degrees of glenohumeral: 0 degrees of scapular
30 - 90 degrees scapula abducts and upwardly rotates 1 degree for every 2 degrees of humeral elevation
Above 90 degrees scap and humerus move 1:1 |
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What is impingement? |
Compression of suprahumeral structures against the anterior inferior aspect of acromion
Irritation of supraspinatus, long head of bicep and subacromial bursa also
Occurs during horizontal adduction, abduction, and flexion above 90 degrees |
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Risk factors for impingement: (5) |
Repetitive overhead tasks Weak/fatigued rotator cuff muscles Internal rotated humerus with abduction Altered scapulo-humeral rythm Subacromial space narrowing (thickening of tendon, congenital) |
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Presentation of impingement (5) |
Edema and inflammation Tenderness to palpation over greater tuberosity / ridge of acromion Painful arc with abduction 60 - 120 deg Painful / weak external rotation of humerus Bicep tendon irritation |
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Dislocation, how much are anterior? complain of what? symptoms? |
90 - 95 % of instabilities anterior Clicking, catching, apprehension Deformity Forced abduction and external rotation to anteriorly translate humeral head |
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What to look for in dislocation: (4) |
Flattened deltoid, prominent humeral head in axilla, arm carried in slight abduction and external rotation, moderate pain and disability |
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Dislocation management (6) |
RICE and reduction by physician Immobolize following reduction 3 weeks isometrics while immobolized Resistance exercises as pain allows Return to play when regained 20% of body weight for internal / external rotation Protective bracing |
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AC joint sprain etiology |
Result of direct blow from any direction, upward force from the humerus 1-6 grading |
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Grade 1 - 3 AC joint sprain |
1 - point tenderness and pain with movement, no disruption of joint 2 - tear or rupture of AC ligament, partial displacement of lateral end of clavicle, pain, point tenderness and decreased ROM (abduction / adduction) 3 - Rupture of AC and CC ligaments |
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Grade 4 - 6 AC joint sprain |
4 - posterior dislocation of clavicel
5 - loss of AC and CC ligaments, tearing of deltoid and trapezius attachments, gross deformity, severe pain, decreased ROM
6 - displacement of clavicle behind the coracobrachialis |
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AC joint sprain management |
Ice, stabilization, refer
grade 1-3, 3-4 days to 2 weeks of immobilization
Grades 4-6 will require surgery
Aggressive rehab required w/ all grades |
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Rehab of AC joint |
immediately: Joint mobilizations, flexibility exercises, strengthening
Progress as athlete is able to tolerate w/out pain or swelling
Padding and protection until pain free ROM |
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Frozen shoulder what is it and stage 1 |
Decrease in ER, abduction, then IR due to capsule tightening (adhesive capsulitis)
Stage 1 - acute pain and inflammation, minimal loss of ROM AROM decreased due to pain lasts 2 - 9 months |
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Stage 2 and 3 |
2 - Pain and stiffness Significant loss of passive and active ROM 4 - 12 months
3 - pain is minimal but ROM remains limited 2 - 5 years |
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Knee what kind of joint? What is stability due to?
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Hinge joint w/ a rotational component
Stability due to ligaments, joint capsules, and muscles |
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Movements of the knee require:
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flexion, extension, rotation, arthrokinematic motions of rolling and gliding
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What is the screw home mechanism?
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As knee extends it externally rotates because the medial femoral condyle is larger than the lateral, provides increased stability to the knee, popliteus "unlocks" knee allowing to flex
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ROM of knee, limited by what?
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140 degrees, limited by shortened position of hamstring, bulk of hamstring, and extensibility of quads
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Patella aids during extension, doing what?
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Distributes compressive stress on the femur by increasing contact between the patellar tendon and femur
Protects patellar tendon against friction Moving from extension to flexion the patella glides laterally and further into the trochlear groove |
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Assessing the knee joint
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Current injury
Past history MOI Did the knee collapse? Hear or feel anything? Could you move your knee or was it locked? Did swelling occur? Where was the pain? |
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Assessing the knee continued 2nd half
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What is your major complaint?
When did you first notice the condition? Is there recurrent swelling? Does the knee lock or catch? Is there severe pain? Grinding or grating? Does it ever feel like giving way? What does it feel like on stairs? What past treatment have you had? |
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What to observe at the knee
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Walking, half sqautting, going up and down stairs
swelling, ecchymosis Leg alignment |
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What to check in leg alignment?
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Genu valgum and genu varum
Hyperextension and hyperflexion Patella alta and baja Patella rotated inward or outward Tibial torsion, femoral anteversion, and retroversion |
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Knee symmetry and leg length
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Does the knee look symmetrical? Is there swelling? Atrophy?
Leg length - anatomical or functional? Anatomical differences can cause problems in all weight bearing joints Functional differences can be cause by pelvic rotations or mal-alignment of spine |
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Palpation of swelling (6)
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Intra vs extra capsular swelling
Intracapsular may be referred to as joint effusion Swelling w/in the joint that is caused by synovial fluid and blood is a hemarthrosis Sweep maneuver Floating patella - sign of joint effusion Extra capsular swelling tends to localize over the injured structure |
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Special test for knee instability (3)
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Use endpoint feel to determine stability
MRI may also be necessary Classification of joint instability |
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Classifications of joint instability (3)
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Knee flexion includes both straight and rotary instability
Translation refers to the glide of tibial plateau relative to the femoral condyles As the damage to stabilizers structures increases, laxity and translation also increases |
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Special knee tests
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Valgus and Varus Stress
Anterior Cruciate Ligament Tests Lachman Drawer Tests (at 90 degrees flexion) - Will not force knee into painful flexion right after injury, reduces hamstring involvement Posterior Sag Test (Godfreys Test) - athlete is supine w/ both knees flexed to 90 degrees |
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Meniscal tests
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McMurray's meniscal Test
Used to determine the displaceable meniscal tear Leg is moved into flexion and extension while knee is IR and ER in conjunction with valgus and varus stressing As positive test is found when clicking and popping are felt |
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Apleys Compression Test
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Hard downward pressure is applied with rotation, pain indicated a meniscal injury
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Apleys distraction test
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Traction is applied with rotation
pain will occur if there is damage to the capsule or ligaments No pain will occur if it is meniscal |
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Girth measurements
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Change in girth can occur due to atrophy, swelling, and conditioning
Use circumferential measures to determine deficits and gains during rehab Measurements taken at specific locations at the leg |
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Subjective rating
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Used to determine patients perception of pain, stability, and functional performance
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Fucntional examination
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Must assess walking, runnin, turning, and cutting
Co-contraction test, vertical jump, single leg hop and duck walk Resistive strength testing |
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Q angle examination
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Lines which bisect the patella relative to the ASIS and the tibial tubercle
Normal angle is 10 degrees for males and 15 degrees for females Elevated angles often lead to pathological conditions associated with improper patella tracking |
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Prevention of knee injuries
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Physical conditioning and rehabilitation
-Total body conditioning (strength, flex, cardio, endurance, agility, speed, balance) - Muscles around joint must be conditioned - Must avoid abnormal muslce action through flexibility |
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Extensibility of what muscles is important to prevent knee injury?
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Hamstrings, erector spinae, groin, quadriceps, and gastroc
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ACL prevention programs
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Strength, neuromuscular control, balance
Series of different programs which address balance board, training, landing strategies, plyometric training, and single leg performance |
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Shoe Type in knee injury prevention
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Change in football footwear has drastically reduced the incidence of knee injuries
Shoes with more short cleats does not allow foot to become fixed, still allows for control with cutting and running |
