tailieunhanh - Care of Musculoskeletal Problems in the Outpatient Setting - part 3

Biến dạng, không có thương tích loại 1, có mặt ở lớp 2 và tổn thương 3. Các biến dạng có thể không được rõ ràng ban đầu vì phù chấn thương. Sự xem mạch thường cho thấy sự âu yếm hơn khớp AC. Kiểm tra chéo (xem Hình 5,12) là tích cực. Xét nghiệm này được thực hiện | 68 . Shahady J. Buseman and A. Nordgren Figure . Grade 3 tear. Reproduced from Shahady E Petrizzi M eds. Sports Medicine for Coaches and Trainers. Chapel Hill NC University of North Carolina Press 1991 52 with permission. ligament. The deformity not present in grade 1 injury is present in grade 2 and 3 injury. The deformity may not be obvious initially because of the edema from the trauma. Palpation usually reveals tenderness over the AC joint. The crossover test see Figure is positive. This test is performed by asking the patient to abduct the painful shoulder to 90 and then adduct the shoulder by attempting to touch his uninjured shoulder with the hand of the injured side. Once the patient has touched the opposite side the examiner pushes down on the elbow of the affected side while the patient resists. With grade 1 injuries like the patient above the crossover maneuver is possible and the patient can resist downward pressure on the elbow but there will be significant pain. With grade 2 injuries the patient can do the crossover maneuver but is not be able to actively resist any force you apply. With grade 3 injuries it is very painful to attempt the crossover test and they usually are unable to complete the task. . Imaging Most diagnoses can be made with a thorough history and physical examination. if a fracture is suspected plain film X-rays of the shoulder are usually sufficient to make the diagnosis. Magnetic resonance imaging MRi would not be indicated unless other injuries are suspected. 5. Shoulder Problems 69 . Treatment For grade 1 to 3 AC injuries ice and NSAIDs are the mainstay of initial treatment. Most AC separations will heal without surgical intervention. A sling is recommended until the pain subsides. The pain lasts for 1 to 6 weeks depending on the grade of separation. Within a few days initiate a rehabilitation program in order to restore a full ROM. The patient is asked to remove the arm from the sling and slowly begin to make