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08.09.2014

Shoulder and collarbone pain, bent over barbell rows - For You

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The shoulder joint is incredibly mobile and relies heavily on muscular function for movement, control and stability. The shoulder is made up of three bones, the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone) as well as associated muscles, ligaments and tendons. The rotator cuff is an anatomical term given to the group of muscles and their tendons that act to stabilize the shoulder. The shoulder must be mobile enough for the wide range of actions that the arms and hands are capable of, but also stable enough to allow for actions such as lifting, pushing and pulling. Prospective evaluation of arthroscopic stabilization of acute, initial anterior shoulder dislocations in young athletes.
A prospective, randomized evaluation of arthroscopic stabilization versus nonoperative treatment in patients with acute, traumatic, first-time shoulder dislocations. This means that specialised treatment and rehabilitation for a shoulder injury is crucial in returning to your pre-injury state.
It is composed of tendons and muscles (supraspinatus, infraspinatus, teres minor and subscapularis) whose job it is to provide dynamic stability to the shoulder joint throughout all ranges of motion. This compromise between mobility and stability results in a large number of shoulder injuries. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.
The clavicle overlies and protects the brachial plexus, pleural cap, and great vessels of the upper extremity.
Ninety percent of shoulder dislocations are anterior (Figure 5),3 with most of the others being posterior.9 Inferior dislocations (luxatio erecta) are rare and often are accompanied by neurovascular injury and fracture. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.
The most common shoulder injuries are rotator cuff injuries, bursitis and frozen shoulder (adhesive capsulitis). The major joint of the shoulder is the glenohumeral joint, which is where the humerus attaches to the scapula. It is important that family physicians understand the anatomy of the shoulder, mechanisms of injury, typical physical and radiologic findings, approach to management of injuries, and indications for referral. In younger patients, most shoulder dislocations are caused by direct trauma and sports injuries. When a tear occurs, patients experience pain and difficulty in abducting or rotating the arm. These occur as a result of two main mechanisms; being macro-trauma (after a tackle on the football field) and repetitive micro-trauma (baseball pitcher or poor computer use). Clavicle fractures are among the most common acute shoulder injuries, and more than 80 percent of them can be managed conservatively. Up to 85 percent of proximal humerus fractures can be treated nonoperatively.2 Evaluation of a patient with a proximal humerus fracture starts with a careful and focused physical examination.


In elderly persons, falls are the predominant cause, and the dislocation often is accompanied by a fracture.
Humeral head fractures are less common and usually occur in elderly persons; 85 percent of them can be managed nonoperatively. Acute complications are uncommon, although pneumothorax, hemothorax, and injuries to the brachial plexus or subclavian vessels have been reported.2 Neurovascular and lung examinations should be performed to screen for these complications.
Neurologic and vascular examinations of the upper extremity should be completed and documented. The ligaments that hold the AC joint together include the acromioclavicular, coracoclavicular, and deltotrapezial fascia.
Common acute soft tissue injuries include shoulder dislocations, rotator cuff tears, and acromioclavicular sprains. A routine anteroposterior view usually is the only radiograph needed to confirm the fracture and specify its location. With enough force, the coracoclavicular ligaments also will be torn, and the deltotrapezial fascia injured or detached. The degree of trauma usually required would be a significant fall, motor vehicle crash, or shoulder dislocation. Types I and II are treated conservatively, types IV to VI are treated surgically, and there is debate about the best approach for type III.
Tenderness and swelling often are diffuse, making it difficult to detect clear point tenderness.Appropriate radiographs are an important part of diagnosing and evaluating proximal humerus fractures. Normally, the humeral head should overlie the point where the three dotted lines meet (center of the Y).Reprinted with permission from Eiff MP, Hatch RL, Calmbach WL. Group 1 (middle one third of the clavicle) is the most common type of break (Figure 2)3 and represents 80 percent of clavicle fractures.1 Group 1 fractures are treated conservatively with an arm sling for comfort, even if significant displacement is present.
Historically, a figure-of-eight bandage was applied, but they are uncomfortable, have a higher incidence of complications, and do not improve functional or cosmetic results.4 Ice and analgesics are helpful in the initial treatment. Traumatic or acute rotator cuff tears can be managed conservatively or surgically, depending on the patient and the degree of injury. Pain and weakness usually are made worse by overhead activities and are present in abduction and external rotation.
Weighted radiographs have been a part of the traditional work-up, but the need for them has come into question.16 Patients with type I injuries should have tenderness over the AC joint, no visible deformity of the distal clavicle, and normal radiographs. MRI has become the imaging standard and has replaced invasive arthrography to assist in the diagnosis.20Initially, conservative treatment is acceptable for rotator cuff tears, but the choice of an operative versus nonoperative approach should be individualized for each patient.
They also will have a positive cross-arm test (sharp pain at the AC joint if the patient holds the arm out straight and brings it across the chest).With type II injuries, the distal clavicle may be slightly more prominent on inspection, and the patient may have pain at the distal end of the clavicle from the sprained coracoclavicular ligament. The rest period should be short (one to two weeks) and should include icing, NSAIDs, and, occasionally, subacromial steroid injections. Gentle range-of-motion exercises (pendulum exercises) should be initiated during the rest period to retard loss of range of motion.


After the pain has subsided, a monitored stretching and strengthening program should be started.
The treatment of type III injuries remains an area of controversy, and patients with these injuries should be referred to an orthopedist for evaluation and possible surgical repair.Treatment of type I and II injuries focuses on symptomatic relief and includes use of a sling for one to three weeks, ice, and nonsteroidal anti-inflammatory drugs (NSAIDs). A bulge may be noticeable where the humeral head rests, with emptiness beneath the acromion where the humeral head should be.Management begins with a careful examination to rule out neurologic or vascular deficits.
Once the acute pain is alleviated, range-of-motion and general strengthening exercises are started. The standard three-view shoulder series should be obtained to ascertain or confirm the diagnosis and to rule out associated fractures. Group 2 fractures that extend to the articular surface, even if nondisplaced, often lead to osteoarthritis of the acromioclavicular (AC) joint.5 Displaced group 2 fractures generally require operative treatment because they are unstable and have a high incidence of nonunion.
They perform this movement by bending at the waist, allowing the arm to fall toward the floor, and rotating it in a circle.
Most patients are able to return to sports, but some may complain of nuisance symptoms such as clicking and pain with push-ups.
Surgical treatment generally results in good function.6Displaced group 3 fractures (medial one third of the clavicle) and sternoclavicular dislocations require orthopedic referral. With time, the size of the circle is increased, and the sling is removed during the exercise.After two to three weeks, abduction (progressively walking fingers up the wall) and internal rotation (first touching hip, then progressing to mid-back) exercises are added. Therefore, reduction should be performed promptly after radiographs are obtained and interpreted.
To avoid this, patients should be encouraged to remove the sling and flex and extend the elbow as soon as this movement can be tolerated. To speed recovery and avoid iatrogenic loss of elbow range of motion, use of the sling should be discontinued completely by four to six weeks after injury.
Early reduction also requires less force, which should reduce the risk of iatrogenic injury. Radiographs should be obtained after reduction to rule out associated fractures that might demand specific treatment. Failure to reduce the dislocation successfully using these methods necessitates reduction under general anesthesia.Treatment after reduction traditionally includes immobilization of the shoulder for four weeks followed by rehabilitation. If conservative therapy is pursued, range of motion should be addressed in the same way as it is in patients with a humerus fracture.



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