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Functional Rehabilitation
Published in James Crossley, Functional Exercise and Rehabilitation, 2021
Movement of the shoulder is supported by the shoulder girdle, the pseudo-joint formed by the scapula gliding over the thorax, and the articulation between the clavicle and sternum medially (the sternoclavicular joint) and acromion process laterally (the acromioclavicular joint).
A to Z Entries
Published in Clare E. Milner, Functional Anatomy for Sport and Exercise, 2019
The acromioclavicular joint is also considered part of the shoulder girdle, since the acromion process is part of the scapula. Several ligaments connect the clavicle to the scapula. At this joint, the acromioclavicular ligament is a thickening of the joint capsule, equivalent to the glenohumeral ligament at the glenohumeral joint. In addition, coracoclavicular ligaments, between the coracoid process and the clavicle assist in keeping the clavicle in place. These ligaments attach to the clavicle medial to the acromioclavicular joint and connect to the coracoid process inferiorly. There are two distinct coracoclavicular ligaments, the trapezoid and conoid, named according to their shape (trapezoidal and cone-shaped). The conoid is the more medial of the two. The important role of these ligaments becomes apparent after an acromioclavicular joint separation. This injury is a dislocation of the acromioclavicular joint which typically occurs as a result of a fall directly onto the shoulder. The severity of the injury is determined by the degree of separation of the clavicle from the acromion process. If only the acromioclavicular joint is torn, there is no apparent separation of the joint because the coracoclavicular ligaments keep the clavicle in place. In a more severe injury, the coracoclavicular ligaments are also torn, and the clavicle is now free to move superiorly and become separated from the acromion. In this case, the lateral end of the clavicle can be identified clearly under the skin as a bump on the superior aspect of the shoulder.
Injuries of the shoulder and upper arm
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Acute injury of the acromioclavicular joint is common and usually follows direct trauma. It represents around 12% of all shoulder injuries. Chronic sprains, often associated with degenerative changes, are seen in people engaged in athletic activities like weightlifting or occupations such as working with jack-hammers and other heavy vibrating tools.
Bilateral ultrasound findings in patients with unilateral subacromial pain syndrome
Published in Physiotherapy Theory and Practice, 2022
Anna Eliason, Marita Harringe, Björn Engström, Kerstin Sunding, Suzanne Werner
During the US examinations the patients were seated on a swivel chair with a low backboard, and the examiner was standing behind the patient. The tendons of supraspinatus, subscapularis, infraspinatus and the long head of biceps were visualized in both a longitudinal and transversal plane. Both the tendons of subscapularis and infraspinatus were evaluated dynamically during internal and external rotation with the forearm in supination and the elbow in 90° of flexion. The acromioclavicular joint was evaluated in terms of possible sprains and osteoarthritis. The supraspinatus tendon and the subdeltoid/subacromial bursae were evaluated dynamically during abduction with the arm slightly internally rotated. The supraspinatus tendon was examined with the patient’s palm placed on the posterior region of the iliac wing with the elbow flexed and directed posteriorly. The US examiner was blinded to arm dominance, the patient´s symptom as well as to the purpose of the study.
Applying a clinical decision-making model to a patient with severe shoulder pain ultimately diagnosed as neuralgic amyotrophy
Published in Physiotherapy Theory and Practice, 2022
Shoulder symptoms may be the most frequently encountered extremity diagnosis in general physical therapy practice and such symptoms account for about 10% of all patients seen in physical therapy (Kooijman et al., 2013). This creates a high economic burden for society with a mean annual cost of 4139 per patient, most of which was attributed to the cost of sick leave in a Swedish study (Virta, Joranger, Brox, and Eriksson, 2012). The shoulder is a particularly complex joint to examine due to the interrelations of the glenohumeral joint (GHJt), the acromioclavicular joint (ACJt), the sternoclavicular joint, the scapulothoracic joint, and cervical spine. The etiology of shoulder joint pain is diverse and includes pain from any of the joints mentioned above, as well as pain from the surrounding soft tissues, ligaments, nerves, and referral from the cervical spine or visceral organs including the heart and lungs. Pathologies involving the GHJt and surrounding soft tissues can include osteoarthritis, bursitis, rotator cuff tendinitis or tear, subacromial impingement, hypermobility, and labral defects to name only a few. Faced with so many possibilities, the differential diagnosis of shoulder pain can be challenging, even to the most experienced physical therapists. More purposeful and deliberate clinical decision-making processes may be helpful to physical therapists when faced with an unusual clinical picture.
Tightrope and Clavicular Hook Plate Technique: A Commentary
Published in Journal of Investigative Surgery, 2022
This investigation assessed type III and V injuries treated either with a Tightrope device or hook plate and screw device [3]. There were significantly more type III injuries than type V in the series, with only type V injuries noted. This limits the applicability of the conclusions to type V, but with thirty type III patients, more of a solid conclusion can be made regarding this subset of acromioclavicular joint injuries. The authors found a strong correlation with accuracy of reduction and functional outcome, and most interestingly, there was no difference between the two implants in regards to either measurement. This differs slightly from some of the existing data and a recent meta-analysis that found increased shoulder scores and pain levels with use of suspensory loop suture techniques with devices such as the Tightrope [4]. This may be due to improved techniques with the series in this investigation or limitations in ability to detect differences due to the relatively small patient cohort size; the differences may also not be noted with type III injuries and/or may be different with each grade change of acromioclavicular joint dislocation.