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Shoulder Injuries Diagnosis and Treatment

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Shoulder Injuries Diagnosis and Treatment SHOULDER INJURIES DIAGNOSIS AND TREATMENT BONE AND JOINT HEALTH JASSIN M. JOURIA Dr. Jassin M. Jouria is a practicing Emergency Medicine physician, professor of academic medicine, and medical author. He graduated from Ross University School of Medicine and has completed his clinical clerkship training in various teaching hospitals throughout New York, including King’s County Hospital Center and Brookdale Medical Center, among others. Dr. Jouria has passed all USMLE medical board exams, and has served as a test prep tutor and instructor for Kaplan. He has developed several medical courses and curricula for a variety of educational institutions. Dr. Jouria has also served on multiple levels in the academic field including faculty member and Department Chair. Dr. Jouria continues to serve as a Subject Matter Expert for several continuing education organizations covering multiple basic medical sciences. He has also developed several continuing medical education courses covering various topics in clinical medicine. Recently, Dr. Jouria has been contracted by the University of Miami/Jackson Memorial Hospital’s Department of Surgery to develop an e- module training series for trauma patient management. Dr. Jouria is currently authoring an academic textbook on Human Anatomy & Physiology. ABSTRACT Over time, the potential for injury or just general wear and tear on bones and joints can impact a person’s quality of life. Even in younger individuals, repetitive activities, such as repeatedly throwing a baseball, can cause arthritic pain and joint tears that cause pain and limit a person’s body to function as it was designed. However, many treatment options, both surgical and non-surgical, are available to provide relief and to restore normal functioning. 1 nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com Policy Statement This activity has been planned and implemented in accordance with the policies of NurseCe4Less.com and the continuing nursing education requirements of the American Nurses Credentialing Center's Commission on Accreditation for registered nurses. It is the policy of NurseCe4Less.com to ensure objectivity, transparency, and best practice in clinical education for all continuing nursing education (CNE) activities. Continuing Education Credit Designation This educational activity is credited for 3 hours. Nurses may only claim credit commensurate with the credit awarded for completion of this course activity. Pharmacology content is 0.5 hour (30 minutes). Statement of Learning Need Issues related to bone and joint health are an evolving area of orthopedic care that involves a multidisciplinary approach to treatment, including medical clinicians, nursing, physiotherapy, occupational therapy and home care. Clinicians need to be informed of how wear and tear on the bones and joints can specifically impact quality of life, and of patient care needs when shoulder and knee surgery is required due to arthritis pain and joint tears. Course Purpose To provide health clinicians with knowledge of shoulder and knee joint disease and recommended treatments, surgery and rehabilitation needed to address pain issues and to improve a patient’s quality of life. 2 nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com Target Audience Advanced Practice Registered Nurses and Registered Nurses (Interdisciplinary Health Team Members, including Vocational Nurses and Medical Assistants may obtain a Certificate of Completion) Course Author & Planning Team Conflict of Interest Disclosures Jassin M. Jouria, MD, William S. Cook, PhD, Douglas Lawrence, MA, Susan DePasquale, MSN, FPMHNP-BC – all have no disclosures Acknowledgement of Commercial Support There is no commercial support for this course. Please take time to complete a self-assessment of knowledge, on page 4, sample questions before reading the article. Opportunity to complete a self-assessment of knowledge learned will be provided at the end of the course. 3 nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com 1. The _____________ joint is the major joint of the shoulder. a. rotator cuff b. humeral c. glenohumeral d. scapula 2. The rotator cuff adheres to the glenohumeral capsule and also attaches to the a. clavicle. b. humeral head. c. radial head. d. lateral epicondyle. 3. True or False: The rotator cuff keeps the humeral head in the glenoid cavity when a person elevates his or her arm. a. True b. False 4. The ____________ are two filmy and sac like structures that allow smooth gliding between bone, tendons, and muscles; they protect and cushion the rotator cuff. a. menisci b. brachii c. bursae d. glenoid labrum 5. __________ are bands of tissues that connect bones and muscles. a. Ligaments b. Tendons c. Bursae d. Cartilage 4 nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com Introduction The human shoulder is uniquely constructed for lifting, pulling, and pushing objects. It is also mobile enough to allow for a wide range of actions of the hands and arms. These actions or functions may be limited by shoulder pain due to injuries and inflammation of a shoulder tendon, joint, surrounding ligament, or periarticular structure. A shoulder examination is needed to evaluate a patient for the possibility of a rotator cuff tendinopathy, rotator cuff tear, frozen shoulder, osteoarthritis, or any number of other disorders at or around the shoulder. Causes of injuries, diagnoses, and treatments, including when surgery should be an option, are important clinical considerations when attempting to determine the course of care for a shoulder injury. Shoulder Anatomy: Overview An understanding of human shoulder anatomy is the starting point for a clinician to know how to treat shoulder injuries, and the associated pain. It is also helpful for educating patients on rehabilitation and recovery.89,90 The shoulder consists of three bones and associated muscles, ligaments, and tendons. The three shoulder bones include the clavicle (collarbone), scapula (shoulder blade), and humerus (upper arm bone). The scapula forms the glenoid cavity, and displays prominent, projecting structures known as the acromion and coracoid processes. Shoulder joints are articulations between the bones of the shoulder. The glenohumeral joint is the major joint of the shoulder, which leads to some clinicians calling it the shoulder joint; however, the shoulder includes the acromioclavicular joint. 5 nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com The glenohumeral joint is where the humerus attaches to the scapula with the head sitting in the glenoid cavity.89,90 It is a ball and socket joint and is formed by the articulation between the lateral scapula (the glenoid cavity of the scapula) and the head of the humerus. The ball part of the ball and socket of the shoulder is a rounded medial anterior surface of the humerus. The socket part is formed by the glenoid cavity – the dish shaped portion of the lateral scapula. It allows the arm to rotate in a circular way or to hinge out and away from the body. Surrounding the shoulder’s ball and socket joint are ligaments, muscles, and tendons that support the bones and maintain a relationship one to another. These supporting structures attach to the humerus, clavicle, and scapula. The capsule of the shoulder is a soft tissue envelope. It encircles the glenohumeral joint and attaches to the scapular, humerus, and head of the biceps. A synovial membrane lines the capsule. It is strengthened by the coracohumeral ligament, which attaches the coracoid process of the scapula to the greater tubercle of the humerus. The glenoid ligaments are three other ligaments that attach the lesser tubercle of the humerus to the lateral scapula. The transverse humeral ligament passes from the lesser tubercle to the greater tubercle of the humerus. The Rotator Cuff The rotator cuff is an anatomical term given to four muscles and related tendons that surround the shoulder joint. Each muscle of the rotator cuff has a tendon attached to it and to the humerus. The muscles associated with the tendons are in the upper back, which is where they attach to the scapula (shoulder blade). 6 nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com The rotator cuff adheres to the glenohumeral capsule and also attaches to the humeral head. It keeps the humeral head in the glenoid cavity and prevents upward migration of the humeral head as caused by the pulling of the deltoid muscle at the time of arm elevation. Rotator Cuff Muscles The four muscles and their specific movements include: • Supraspinatus (used for lifting the arm) • Infraspinatus (help rotate the arm outward) • Teres minor (help rotate the arm outward) • Subscapularis (helps rotate the arm inward) The four rotator cuff muscles work together through contractions. As a person moves the arm, the rotator cuff muscles stabilize and control the humeral head that is the ball part of the ball and socket joint. Each muscle works independently but with other muscles and fibers, they work together to articulate shoulder movement; i.e., the teres minor and infraspinatus with the anterior fibers of the deltoid muscle allow for external rotation of the arm.89-91 Rotator Cuff Tendons The four tendons of the rotator cuff converge to form the rotator cuff tendon that is the upper arm band. The tendons attach to the side and front of the humerus and the greater and lesser tubercles that
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