S.I.C.K. SCAPULAIN A

HIGH SCHOOL ATHLETE

By Chelsey Toney

BONY/ SOFT TISSUE ANATOMY

3/26/2013

S: C/C: 16 year old male Hockey and Lacrosse player came in with right clavicle fracture. MOI: Was going into corner at rink and kid put him in a head lock, kicked him, and landed on top of his right shoulder and then kid landed on top of his left shoulder. Immediate sharp pain in right shoulder, couldn’t move extremity, and knew his clavicle was fractured. Was given ice and sent to the hospital. Took x-rays, put him in a sling, and gave him pain medicine. Pain scale 10/10 at rest and with movements. Medical Hx: Type 1 diabetes. Past Hx: 2nd degree tear to AC Joint right and left. Right scaphoid fracture 6 months ago.

O: Obvious deformity, right arm held down to side. When palpating, obvious deformity near AC joint, pushed back. A/PROM: compared bilaterally no ROM because of pain level. Strength Tests/ MME: N/A. Special Tests: N/A.

A: Fracture to right clavicle

P: Leave in sling. 1 or 2 days daily take out to stretch elbow. Ice as needed (20 min on 20 min off). Will be going to doctor. Possible surgery with plate to realign and heal correctly. Ibuprofen or Tylenol when needed. If no surgery 4-6 weeks in sling to heal.

PICO

P: Athlete, 16 year old male, Hockey and Lacrosse, Clavicle fracture

I: Sling 4-6 weeks

O: Healing long-term

SOAP NOTE

Patient’s Clavicle

Patient X-Ray

ACTION DEGREES

FLEXION 180°

EXTENSION 50°

ADDUCTION 40°

ABDUCTION 180°

MEDIAL ROTATION

90°

LATERAL ROTATION

90°

ROM MEASUREMENTSJOINT MOTION OF SHOULDER

NORMAL

ACTION RIGHT LEFTFLEXION 173° 180°EXTENSION 44° 57°ADDUCTION ---------------

--------------------

ABDUCTION 180° 180°MEDIAL ROTATION

60° 78°

LATERAL ROTATION

107° 107°

PROM

ACTION RIGHT LEFTFLEXION 155° 180°EXTENSION 31° 43°ADDUCTION -------------

-------------------------

ABDUCTION 150° 180°MEDIAL ROTATION

62° 105°

LATERAL ROTATION

55° 96°

AROM

Prominence of Inferomedial border of Scapula

Thoracic Kyphotic Curve of Spine

The AC joint stabilizes the scapula in relation to the clavicle by three ligaments.

AC JOINT/ LIGAMENT

- Coracoacromial ligament

- Coracoclavicular ligament

- Acromioclavicular ligament

S: Scapular Malposition on rib cage

I: Inferior Medial Scapular Winging

C: Coracoid Tenderness

K: Scapular Dyskinesis

S.I.C.K. SCAPULADEFINED

Asymmetric malposition of the scapula that will appear as if one shoulder is lower than the other.

SCAPULAR MALPOSITION

Contributes to loss of power and limited flexion and abduction of the upper extremity. It is usually due to weak Serratus anterior, Trapezius, and Rhomboid muscles.

INFERIOR MEDIAL SCAPULAR WINGING

The Pectoralis minor tightens as the coracoid tilts inferiorly and shifts laterally away from the midline, and its insertion at the coracoid becomes very tender.

CORACOID TENDERNESS

Alteration of the normal position or motion of the scapula during coupled scapulohumeral movements.

Dyskinetic patterns fall into 3 categories characterized by:

SCAPULAR DYSKINESIS

http://www.youtube.com/watch?v=HRalJc5T_5g

Type 1 – Prominence of the inferomedial border of the scapula

Type 2 – Prominence of the entire medial border

Type 3 – Prominence of the superomedial border

• A resting posture of thoracic kyphosis and increased cervical lordosis , results in:

- Excessive scapular protraction

- Acromial depression in all phases of athletic activity

• Fractures of the clavicle can:

- Shorten or angulate the strut, which helps maintain proper scapular position.

• Acromioclavicular joint injuries, instabilities, or arthrosis also:

- Interfere with clavicular strut function

- Can alter scapular kinematics

• Bony abnormalities such as malunion of a clavicular fracture or an acriomioclavicular joint separation may be the cause of dyskinesis.

RESULTS FOUNDAccording to W. Ben Kibler, MD…

- Targeting kyphotic postureTreatment objectives:

1. Increase mobility and elasticity of the thoracic spine in the direction of extension

2. Reinforcement of the endurance capability of trunk extensor muscles

3. Recover of muscular retractions when present

4. Learning of correct posture to be

adopted in everyday life activities

REHABILITATIVE APPROACH

- Targeting S.I.C.K. Scapula, specifically Scapular Dyskinesis

Emphasizes to achieve full and appropriate scapular motion and coordinating that motion with complementary trunk and hip movements

1. Correcting any strength or flexibility deficits

in the low back and thoracic

levels – Flexibility exercises, strengthening trunk,

and correction of postural abnormalities

2. Scapular retraction and massage can

increase the tightness of the

coracoid-based muscles.

3. As scapular control increases, scapular exercises

can progress by decreasing the emphasis on proximal

facilitation to distal.

REHABILITATIVE APPROACH

Burkhart, S, Morgan, C, Kibler, B. The Disabled Throwing Shoulder: Spectrum of Pathology Part 3: the

SICK Scapula, Scapular Dyskinesis, the Kinetic Chain, and Rehabilitation. The Journal

of Artroscopic and Related Surgery. 2003 July-August;19(6):641-661. Published 2003. doi:

10.1016/S0749-8063(03)00389-X

Fish, D, Martin, R. Scapular winging: anatomical review, diagnosis, and treatments. Curr Rev Musculoskelet Med. 2008 March; 1(1):1–11. Published online 2007 November 2. doi: 10.1007/s12178-007-9000-5

Gumino, A, Carbone, S, Postacchini, F. Scapular Dyskinesis and SICK Scapula Syndrome in Patients

with Chronic Type III Acromioclavicular Dislocation. The Journal of Arthroscopic and Related

Surgery. 2009;25(1):40-45.

Kibler, B, McMullen, J. Scapular Dyskinesis and Its Relation to Shoulder Pain. Journal of the American

Academy of Orthopaedic Surgeons. 2003;11(2):142-151.

Smith, L. Posture – Let’s Set Things Straight...Just How Important Is Posture? Dr. Larry’s Newsletter.

2005. Available at: http://www.drlarrysmith.com/june2005.htm . Accessed April 17, 2013.

Zaina, F, Atanasio, S, Ferraro, C, Fusco, C, Negrini, A, Romano, M, Negrini, S. Review of rehabilitation

and orthopedic conservative approach to sagittal plane diseases during growth: hyperkyphosis,

junctional kyphosis, and Scheuermann disease. European Journal of Physical and Rehabilitaton

Medicine. 2009;45:595-603.

WORKS CITED Acromioclavicular Joint Separation. Methodist Orthopedic’s and Sports Medicine Web site. 2001. Available at: http://www.methodistorthopedics.com. Accessed April 16, 2013. Bronfort, G, Evans, R, Anderson, A, Svendsen, K, Bracha. Y, Grimm, R. Spinal Manipulation, Medication, or Home Exercise with advice for Acute and Subacute Neck Pain. Ann Intern Med. 2012;156(1_Part_1):1-10.