...Rehabilitation of Acromioclavicular Joint Separations: Operative and Nonoperative Considerations Mark P. Cote, PT, DPTa, Karen E. Wojcik, MSPT, ATCb, Gregg Gomlinski, MSPT, CSCSb, Augustus D. Mazzocca, MS, MDa,* Acromioclavicular joint (AC) separations are one of the most common injuries seen in orthopedic and sports medicine practices, accounting for 9% of all injuries to the shoulder girdle.1–3 Various operative and nonoperative treatment schemes have been described for the management of AC joint injuries.4–33 Although considerable controversy exists over the efficacy of surgical reconstruction versus nonoperative intervention for grade III type injuries, grade I and II separations seem to respond favorably to conservative management. Conversely, grades IV, V, and VI often require surgical reconstruction. Regardless of the type of injury, rehabilitation as a part of conservative management and postoperative care plays an important role in the management of these injuries. This article presents the authors’ rehabilitation approach to treatment of acromioclavicular separations pre- and postoperatively. CONCEPTUAL FRAMEWORK To provide instruction and insight for rehabilitation clinicians, protocols are often provided for a specific injury or procedure. A protocol is a system of rules or procedures for a given situation. Although intended to be informative, protocols often result in a restrictive list of exercises and arbitrary time frames that a clinician...
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...VACUUMING INTRODUCTION Vacuuming: nearly everyone is doing it! Unlike jumping a horse or throwing a curve-ball, vacuuming does not discriminate or limit itself to highly trained individuals or athletes. A vacuum cleaner, or commonly known as a vacuum, is typically an electric device that by means of suction collects dirt and small particles from a variety of surfaces. All it functionally requires is electricity, a vacuum cleaner appliance and a willing and able individual. This common invention is everywhere; household closets, hotels, general workplaces, restaurants and just about any other place that has carpeting or accumulates dust. 700 B.C. was the first noted appearance of woven forms of floor coverings and one could debate that primitive cleaning methods were developed thereafter (carpetandrugpedia.com). A cleaning method other than the traditional “carpet beater” was born in the mid-1800s. This time is known as the industrial revolution and was a critical in the invention of the vacuum cleaner. Factories were producing thousands of manufactured items and with it came an overwhelming amount of dust, soot and industrial pollution. This was also during the same time that infectious disease was being linked to germs. The need for hygiene and cleanliness was born and gave birth to the idea of the vacuum cleaner. By a patent issue date in 1860, Daniel Hess appears to have invented the first device to have the some of the basic principles of the modern vacuum. The...
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...Muscles of the Shoulder/Upper Arm Movements of the Humerus (upper arm at the shoulder) • Movements of the humerus: – – – – – Flexion and Extension Abduction and Adduction External and Internal Rotation Horizontal flexion or Horizontal adduction Horizontal extension or Horizontal abduction Flexion and Extension Abduction and Adduction External and Internal Rotation Horizonal flexion or adduction Horizontal extension or abduction Muscles of the Shoulder/Upper Arm • Anterior: – Pectoralis major, Coracobrachialis, Subscapularis Pectoralis major • Origin: – Clavicle, sternum, and costal cartilage of ribs • Insertion: – Near the intertubercular groove of the humerus • Actions: – Flexion, horizontal flexion, internal rotation, adduction • Used in bench press, pushup, pull-ups, throwing, tennis serves Pectoralis Major Coracobrachialis • Origin: – Coracoid process of scapula • Insertion: – Humerus (medial) • Actions: – Flexion, adduction, horizontal flexion – Primarily an assisting muscle Coracobrachialis Subscapularis • Origin: – Subscapular fossa of scapula • Insertion: – Lesser tubercle of humerus • Actions: – Internal rotation, extension and adduction Subscapularis Muscles of the Shoulder/Upper Arm • Superior: – Deltoid, Supraspinatus Deltoid • Origin: – Clavicle, scapula • Insertion: – Deltoid tuberosity of humerus • Actions: – Abduction – Anterior deltoid: horizontal flexion...
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...limitation of movements of the left shoulder. Indeed, this is a patient who would have dislocated the same shoulder several times During the meetings of volleyball and / or during seizures (according the héteroanamnèse) and each time a spontaneous reduction occurred. Six months ago, he felt the same effect without spontaneous improvement, it would minimized the facts and since then the pain never stopped, followed by progressively of the installation of a restricting the movement of the shoulder. In our review, we noted, an asymmetry of the shoulders, the sign of the shoulder, an emptiness of the glenoid and limitation of movement of the shoulder, especially abduction of the arm. The patient had radiographs made an weeks prior to our consultation that showed the glenoid uninhabited. We found an old or neglected dislocation of the left shoulder. as attitude, we decided to try in vain for a reduction (after a re- Another recent x-ray) under general anesthesia despite the time elapsed. Faced with this therapeutic impasse due to the formation of a néoarthose one hand and the filling of the glenoid by fibrous tissue on the other hand, solutions treatment remaining: Abstention when the pain is simply tolerated by the patient; In our environment resected humeral head (shoulder dangling) that will solve the problem of pain but not functional; when pain gene the patient; Or a total hip replacement (arthroplasty of the shoulder) achievable under other skies ...
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...SLAP Lesion Tear A SLAP lesion tear is an injury to the shoulder. This can cause painful symptoms and difficulty with overhead activities whether they be athletic or those of daily living. In 1985, Andrews et al were the first to describe the superior labrum tear. In their experience, they identified tears of the labrum from throwing athletes located anterosuperor near the origin of the bicep tendon. The cause of the lesion to tear was the bicep tendon being pulled off the labrum from the force generated during the throwing motion. As time went on, the labral tears got categorized into four different types of classifications called SLAP lesions by Snyder in 1990. A SLAP lesion, as described by Snyder involves tears of the superior aspect of the glenoid labrum that extend anteriorly and posteriorly to the biceps insertion. As an examiner, in order to detect a SLAP lesion, there needs to be an investigation of patients activities, any previous shoulder injuries, and or any factors that could lead up to this injury. The highest incidence of SLAP lesions is seen in the 20 to 29 and 40 to 49 years of age. In order to understand the mechanism of a SLAP lesion it is best to understand the anatomy of the shoulder. The shoulder is a ball and socket joint made up of three bones: humerus that is the upper arm bone, shoulder blade of the scapula, and the clavicle. The humerus bone fits into the rounded socket of the scapula, which is called the glenoid fossa. Surrounding the outside...
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...Dance Injuries and Prevention By Katrina Thompson Kin 380, Thomson April 20, 2011 Dance Injuries and Prevention Next to stage fright, the biggest nightmare for a dancer is to become injured. Injuries, depending on the severity, can mean the end of a career in dance and an end to something that you enjoy doing. According to a survey conducted on the injuries obtained by Broadway dancers, the most common injuries occurred on the lower extremities of the body at fifty two percent, followed by the back at twenty two percent, and the neck at twelve percent. The least frequent injuries occurred in the upper extremities with the shoulder consisting of only six percent of the dancers. Of the lower extremities the knee (29%), ankle (25%), foot (20%), and the hip (12%) were the more frequent sites of injury (Evans, Evans, Carvajal, Perry). In order to prevent these types of injuries from occurring it’s imperative that dancers follow the proper precautions such as stretching, proper warm-up techniques and general care for their bodies. After acquiring an injury you must follow proper treatments in order to recover effectively. Your spine is made up of three sections; the top portion or the cervical, the middle portion or the thoracic, and the lower portion or the lumbar (Anderson, Parr, and Hall). When it comes to back injuries, dancers tend to get injured in their thoracic or lumbar regions. The most common injury is frozen back. Frozen back is when the muscles in the back...
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...Introduction Shoulder joint replacement is surgery to replace damaged parts of the shoulder joint with artificial parts (prostheses). Two parts may be used to replace this joint: The humeral component replaces the head of the upper arm bone (humerus). This is a rounded ball that is attached to a stem that fits into the humerus. The glenoid component replaces the socket (glenoid depression). The prostheses are usually made of metal and plastic. Depending on the damage to your shoulder, the surgeon may replace just the humeral head (hemiarthroplasty) or both the humeral head and the glenoid (total shoulder replacement). The surrounding muscles and tendons hold the prosthetic parts in place. This procedure may be done to relieve joint pain, treat...
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...Different types of treatments include resting the shoulder, icing, limiting the use of the shoulder in activities that would cause pain, and pain medications. Other kinds of treatment are electrical muscle stimulation, ultrasound, heat, interferential therapy, and physical therapy. Specific rehab would include exercises to strengthen your shoulder and help with range of motion and flexibility. Different types of exercises would include pendulum, T-bar, and rope-and-pulley exercises that should be done early in the rehabilitation process (Anderson & Parr, 2013). Strengthening the other muscles that help support the shoulder can help prevent the injury from getting worse and relieve some of the pain. Injections or surgery are also an option for more severe cases. The different types of surgery would be arthroscopic tendon repair, tendon transfer, open tendon repair, bone spur removal, and should replacement. Not having surgery when you have a rotator cuff tear can limit the activities that you can do, the tear can get worse, and your strength in your shoulder will stay the same or decrease...
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...Sports Injury Assignment Moira Ijzerman Georgetown District High School Patellar Dislocation What is a Patellar Dislocation? The patella rests in a groove on the anterior aspect of the femur, called the patellofemoral groove (American Academy of Orthopedic Surgeons, 2011). Patellar dislocation occurs when the patella (kneecap) slides laterally out of the patella femoral groove where it normally rests (Ebraheim, 2011). Anatomy The patella bone protects the largest joint in the body, the knee (Temertzoglou & Challen, 2003). The knee is made through the union of 3 bones; the femur, tibia and the patella. (Physio Advisor, n.d.). The patella is situated at the anterior aspect of the knee and lies within the patellofemoral groove (Ebraheim, 2011) which, according to Physio Advisor (n.d.) is located on anterior of the femur. The patella is enveloped by the tendon of the quadriceps muscle, and then goes on to attach to the anterior surface of the tibia (Physio Advisor, n.d.). This relationship forms a joint designed to give the quadriceps muscle leverage when extending the knee (Sports Injury Clinic, n.d.). Each of the bones involved is lined with cartilage to allow cushioning between the bones. The patella also has connective tissue known as the patella retinaculum which attaches it on either side of the femur. This joint is known as the patellofemoral joint (Physio Advisor, n.d.). The patella normally lies in the patellofemoral grove and is only designed...
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...and also complement each other. Arm circles is a workout in which you spread your arms out and move them in a circular motion. Arm circles are also a mobility and stability exercise for the shoulder girdle. The shoulder joint have the weakest and least amount of connective tissue surrounding it. These smaller tendons and muscles often get neglected, which may lead to shoulder injury and pain of varying degrees. Performing arm circles is a good way to develop awareness of the shoulder girdle. This will not only help with stabilizing the shoulders, but it will also help improve the posture. Pros There are many benefits you can get from doing arm circles on a regular basis. They are easy to do and you can do them anywhere. This workout does not require any equipment such as weights, restraints, or mats. In addition, arm circles require little to no concentration so you can watch television or listen to music while doing this workout. You can do arm circles bare footed, in sneakers, or in heels. The only key factor you must remember when doing this workout is you must stand for this workout to actually work properly. According to the website LIVESTRONG.com, you must spread your feet about the width Of your shoulders and raise your arms straight sideways creating a T shape. You must hold your Arms stiff and push your muscles out tight. The good thing about this workout is that you get Resistance exercise without...
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...Running Title: Acute posterior sternoclavicular fracture-dislocation in a 10-year-old boy Authors: Joseph Y. Choi, MD, PhD, Devin P. McFadden, MD, Vipul N. Nanavati, MD Corresponding Author: Francis G. O’Connor, MD Introduction A 10-year-old male was referred to the office after falling onto his left shoulder while playing football. At presentation, he denied any numbness, tingling or loss of sensation of his left upper extremity. Examination of his shoulder girdles revealed an internally rotated left shoulder and shortened clavicular distance. He did have a visible deformation of his left clavicle when compared to the contralateral, uninjured side and had excruciating pain to palpation of the clavicular and sternoclavicular area. The patient had full flexion and extension at the elbow. Shoulder deltoid was intact as were internal and external rotation of his shoulder. Furthermore, the patient denied being short of breath, feeling dizzy, or with difficulty swallowing. Radiographs of the left clavicle and sternoclavicular joint (SCJ) at the initial visit were remarkable for a posterior dislocation of the clavicle. A magnetic resonance imaging (MRI) study of the left clavicle and SCJ revealed that it was posteriorly displaced and edema was present at the fracture site. The physeal attachment to the manubrium was intact. Furthermore, the anterior portion of the clavicle was abutting the brachiocephalic and left subclavian vein (Figure 1). ...
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...This case study is of a male patient that was observed while interning at Action Potential Physical Therapy clinic. The patient was being seen for pain in his right shoulder and diagnosed with poor rotator cuff muscle strength. He was referred so that the physical therapist can help reduce his symptoms and get him back to his quality of life. Back in 2004 he had a rotator cuff repair and initially began receiving physical therapy. The patient however did not finish his treatment and always felt slight discomfort. It was not until recently that he began feeling more troubling and sharp pain in his shoulder. His symptoms have been chronic but mild, he did not seek out professional help until 2/7/17. He experienced discomfort when he slept on...
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...of your shoulder (subscapularis, infraspinatus, supraspinatus, and teres minor) and their tendons become irritated or inflamed. Symptoms include pain and swelling of your shoulder and deltoid, pain when raising or reaching your arm behind your back, clicking sound when raising your arm, stiffness of arm and shoulder, and loss of mobility. This injury is mostly common in athletes and middle-aged people. Repetitive arm movements that involve overhead movements (painting, throwing, lifting, etc.), sleeping on your shoulder frequently, or degeneration with age can cause this condition. Athletic activities that require raising your arm over your shoulder such as with swimming, pitching, and playing tennis are also an origin of this injury....
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...Shoulder injuries are common, especially for people who do a lot of exercise or practice any sport; one of the most frequent injuries to the lesion is called "rotator cuff". The shoulder joint is used to join the arm with the upper body, bones that are taking part are: 1. scapula (the part of the trunk), 2. humerus (arm bone). The bones of the shoulders are covered by a tissue called cartilage, the smooth surface of the cartilage allow for smooth movement and pain-free shoulder. The ligaments being to connect the bones and help keep the shoulder in place. This conformation allows the muscles involved to move the shoulder in all directions. Causes The injuries to the rotator cuff may occur due to: 1. A fall or a specific trauma to the shoulder,...
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...with a 2-year history of progressive weakness and discomfort in her right shoulder, especially when she puts dishes on the top shelf in her kitchen. She is otherwise healthy and has had no injuries. Her physician diagnosed “bursitis” and gave her four subacromial corticosteroid injections; the first two seemed to relieve her symptoms temporarily, but the last two were ineffective. Physical examination reveals some atrophy of the muscles of the right shoulder and weakness when her right arm is elevated. Magnetic resonance imaging (MRI) reveals a large defect in the rotator cuff. How should her case be managed? The Cl inic a l Probl e m From the Department of Orthopaedics and Sports Medicine, University of Washington, Seattle. N Engl J Med 2008;358:2138-47. Copyright © 2008 Massachusetts Medical Society. The rotator cuff is a synthesis of the capsule of the glenohumeral joint with the tendons of the subscapularis, supraspinatus, infraspinatus, and teres minor muscles (Fig. 1).1 The rotator-cuff mechanism precisely centers the humeral head by compressing it into the glenoid concavity. The individual muscles of the cuff help to provide strength in arm movement: the subscapularis in internal rotation, the supraspinatus in elevation, and the infraspinatus and teres minor in external rotation. Failure of the rotator-cuff tendons due to either tear or wear is the most common clinical problem of the shoulder, accounting for more than 4.5...
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