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Lecture

PEDS240 Lecture Notes - Axilla, Subacromial Bursa, Myositis Ossificans

9 Pages
110 Views
Winter 2013

Department
Physical Education and Sport
Course Code
PEDS240
Professor
Brad Kern

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Know major muscles and the origins, actions and insertions
If you palpate this structure, and theres tenderness, what happened?
A varus foot will lead to a valgus knee.
March 25 – Ch18 Shoulder
Apprehension test is used to test for shoulder dislocation and we are assessing the
integrity of the anterior joint capsule in the shoulder. There will be a feeling of the
joint slipping.
Test for Shoulder Impingement
In neers test, we internally rotate the arm then full shoulder flexion. It will
test for biceps and supraspinatus impingement
Hawkins-Kennedy test is a passive test and can help us tell supraspinatus
muscle injury.
Test for Supraspinatus Weakness
Empty Can Test
90 degrees of shoulder flexion, internal rotation and 30 degrees of horizontal
adduction
Downward pressure is applied
Weakness and pain are bilaterally assessed
Test for SC Stability
Grab the clavicle and move it around anteriorly, posteriorly, superiorly and
inferiorly
Recognition and Management of Specific Injuries
Clavicular Fractures
Cause of Clavicular Fractures
Fall on outstretched arm, fall on tip of shoulder or direct impact
Clavicle is one of the most frequently fractured bones in the body
Occur primarily in middle third (greenstick fracture often occurs in young
athletes)
Signs of a Clavicular Fracture
Presents with supporting of arm, head tilted towards injured side with chin
turned away
Clavicle may appear lower
Palpation reveals pain, swelling, deformity and point tenderness
We may see tentpole deformity or step deformity.
Caring for a Clavicular Fracture
Closed reduction – sling and swathe, immobilize with figure 8 brace for 6-8
weeks
Removal of brace should be followed with joint mobes, isometrics and use of
a sling for 3-4 weeks
Occasionally requires operative management
Fractures of the Humerus
Causes of a Fractured Humerus
Shaft fractures occur as a result of a direct blow, or fall on outstretched arm
Proximal fractures occur due to direct blow, discoloration, fall on outstretched
arm
Signs of a Fractured Humerus
Pain, swelling, point tenderness, decreased ROM
X-ray is positive for fracture
Caring for a Fractured Humerus
Immediate application of splint, treat for shock and refer
Athlete will be out of competition for 2-6 months depending on location and
severity of injury
Sternoclavicular Sprain
Cause of a Sternoclavicular Sprain
Indirect force, blunt trauma
Signs of a Sternoclavicular Sprain
Grade 1 – pain and slight disability
Grade 2 – pain, sublaxation with deformity, swelling and point tenderness and
decreased ROM
Grade 3 – gross deformity (dislocation), pain, swelling, decreased ROM
(possibly life-threatening if dislocates posteriorly) this is called retrosternal
displacement
Caring for a Sternclavicular Sprain
PRICE, immobilization
Immobilize for 3-5 weeks followed by graded reconditioning
Acromioclavicular Sprain

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Description
Know major muscles and the origins, actions and insertions If you palpate this structure, and theres tenderness, what happened? A varus foot will lead to a valgus knee. March 25 – Ch18 Shoulder Apprehension test is used to test for shoulder dislocation and we are assessing the integrity of the anterior joint capsule in the shoulder. There will be a feeling of the joint slipping. Test for Shoulder Impingement • In neers test, we internally rotate the arm then full shoulder flexion. It will test for biceps and supraspinatus impingement • Hawkins-Kennedy test is a passive test and can help us tell supraspinatus muscle injury. Test for Supraspinatus Weakness Empty Can Test • 90 degrees of shoulder flexion, internal rotation and 30 degrees of horizontal adduction • Downward pressure is applied • Weakness and pain are bilaterally assessed Test for SC Stability • Grab the clavicle and move it around anteriorly, posteriorly, superiorly and inferiorly Recognition and Management of Specific Injuries Clavicular Fractures Cause of Clavicular Fractures • Fall on outstretched arm, fall on tip of shoulder or direct impact • Clavicle is one of the most frequently fractured bones in the body • Occur primarily in middle third (greenstick fracture often occurs in young athletes) Signs of a Clavicular Fracture • Presents with supporting of arm, head tilted towards injured side with chin turned away • Clavicle may appear lower • Palpation reveals pain, swelling, deformity and point tenderness • We may see tentpole deformity or step deformity. Caring for a Clavicular Fracture • Closed reduction – sling and swathe, immobilize with figure 8 brace for 6-8 weeks • Removal of brace should be followed with joint mobes, isometrics and use of a sling for 3-4 weeks • Occasionally requires operative management Fractures of the Humerus Causes of a Fractured Humerus • Shaft fractures occur as a result of a direct blow, or fall on outstretched arm • Proximal fractures occur due to direct blow, discoloration, fall on outstretched arm Signs of a Fractured Humerus • Pain, swelling, point tenderness, decreased ROM • X-ray is positive for fracture Caring for a Fractured Humerus • Immediate application of splint, treat for shock and refer • Athlete will be out of competition for 2-6 months depending on location and severity of injury Sternoclavicular Sprain Cause of a Sternoclavicular Sprain • Indirect force, blunt trauma Signs of a Sternoclavicular Sprain • Grade 1 – pain and slight disability • Grade 2 – pain, sublaxation with deformity, swelling and point tenderness and decreased ROM • Grade 3 – gross deformity (dislocation), pain, swelling, decreased ROM (possibly life-threatening if dislocates posteriorly) this is called retrosternal displacement Caring for a Sternclavicular Sprain • PRICE, immobilization • Immobilize for 3-5 weeks followed by graded reconditioning Acromioclavicular Sprain Cause of acromioclavicular sprains • Result of direct blow (from any direction), upward force from humerus, fall on outstretched arm Signs of an Acromioclavicular Sprain • Grade 1 – point tenderness and pain with movement; no disruption of AC joint • Grade 2 – tear or rupture of AC ligament, partial displacement of lateral end of clavicle; pain, point tenderness and decreased ROM (abduction/adduction) • Grade 3 – rupture of AC and CC ligaments with dislocation of clavicle; gross deformity, pain, loss of function and instability Caring for a Acromioclavicular Sprain • Ice, stabilization, referral to physician • Grade 1-3 (non operative) will require 3-4 days (grade 1 ) and 2 weeks of immobilization (grade 3) respectively • Aggressive rehab is required with all grades • Joint mobilizations, flexibility exercises, and strengthening should occur immediately • Progress as athletes is able to tolerate without pain and swelling • Padding and protection may be required until pain-free ROM Glenohumeral Dislocations Cause of a Glenohumeral Dislocation • Head of humerus is forced out of the joint • The most common dislocation, which is an Anterior dislocation is the result of an anterior force on the shoulder, forced abduction, extension and external rotation. It will dislocate anteriorly and inferiorly to the cor
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