Injury Assignment

Izumi’s motorcycle is facing straight towards the intersection, and there are no other vehicles in his lane. The light turns green and he moves slightly into the intersection (His front tire is past the pedestrian walk), waiting for all the vehicles in front of him to pass straight through. He stares at the lane he’s planning to make a left turn to, checking to see if there are any pedestrians nearby. By now, all the vehicles from the opposing road have gone straight, so Izumi proceeds with his left turn. Izumi makes a mistake by accelerating straight ahead too quickly but before he can reduce his speed, he notices a pair of headlights on his right. To his surprise, a car on his right is going 35km/h and is unable to come to a full stop due to the icy roads. Luckily for him, there was enough space between him and the car for him to not get hit. The car was able to speed past him but he slammed on his front brakes too hard due to the unforeseen car. One thing that you shouldn’t do during the winter is brake too hard. The hard braking combined with his new tires caused his motorcycle to topple over on his left side. Both of his legs were still wrapped on the motorcycle and his right hand was still gripping on the handlebar. His left arm, however, was abducted due to his reflexes. He subconsciously abducted his left arm out (90 degree angle) as an attempt to prevent himself from hitting the ground (which did not work out as he planned). His left arm hit the ground hard. Izumi’s head collided onto his abducted arm (180 degree angle), and his arm moved laterally, placing a lot of stress on his shoulder. Izumi felt a snapping sensation on his left upper arm. He simultaneously felt an extreme pain in his left upper arm and shoulder. Izumi attempted to lift his left arm up but he was just overcome with weakness. He crawled off the motorcycle and laid parallel to it, holding his left arm with his right hand. He heard a distinct snapping and clicking sound every time he tried to lift his left arm. He saw that anytime he attempted to reach for his back, lift his arm over his head, and lift it away from his body, it would be extremely difficult to perform.

During

During

After

Pedestrians began to swarm around Izumi as he laid on the road. A few pedestrians assisted him in getting up on his feet. There were witnesses who stepped out of their vehicle to check on him, and even offered to drive him to the hospital. Izumi had to be driven to the hospital because he had lost a great amount of movement in his left arm. His injury may resemble other injuries so his left arm must be evaluated and given the most effective treatment.

After

At Hospital pt. 1

To initially diagnose the type and extent of the injury, the doctor used inspection and palpation. Izumi was asked to remove his clothes and to change into a patient gown. The doctor began their inspection by observing how Izumi moved and carried his shoulders. The doctor was looking for any swelling, asymmetry, deformity, ecchymosis, and venous distention, which Izumi did not seem to have. No deformity suggested that Izumi did not have an anterior dislocation. The doctor used palpation on the acromioclavicular joint, sternoclavicular joint, biceps tendon, acromion, scapula, and coracoid process to confirm for any more possibility of deformity or tenderness. The doctor conducted range of motion tests to assess active and passive ranges. Izumi’s injury extended as to having the loss of a lot of active motion, which indicated that he more likely has muscle weakness rather than a joint disease. Bursitis is a common shoulder injury as well as a joint disease, so it was ruled off. The doctor planned to perform several physical examinations to evaluate his injury. The doctor suspected that Izumi had a rotator cuff injury, due to it being one of the most common shoulder injuries. Izumi was experiencing pain with weakness, which was a key finding to diagnosing a rotator cuff problem. The doctor performed the Drop Arm Test, Hornblower’s Test, Bear Hug Test, and Infraspinatus Test. The Drop Arm Test is a test that is performed when there is a suspicion of a rotator cuff tear, the supraspinatus in particular. The patient’s affected arm is passively abducted 90 degrees away from the median, keeping your arm straight. The healthcare provider then releases their hold on your arm. The test is considered negative if the patient’s arm does not drastically drop their arm and is able to hold that position. A positive occurs when the patient’s arm drops drastically. Izumi tested positive in this test, which indicated that he indeed has a supposed rotator cuff tear. This test could also assess for a full thickness rotator cuff tear.

At Hospital

At Hospital pt. 2

The Hornblower’s Test is a test conducted to determine the tear of the teres minor. The patient’s arm is passively placed 90 degrees in the scapular plane while their elbow is passively flexed at 90 degrees. The healthcare provider places their hand on their arm and asks them to attempt to externally rotate their arm while being resisted by the healthcare provider. The patient will test positive if they can not withstand the resistance, and will test negative if they can. Izumi was able to conduct the external rotation which meant that his teres minor was not torn. The bear hug test is a test that determines the tear of the subscapularis. The palm of the affected arm is placed onto the patient’s opposite shoulder with their fingers extended so that they can’t grab hold of their shoulder. The healthcare provider will use an external rotation resisting force on their forearm. This resistance forces the patient to conduct an internal rotation. The patient will test positive if they are not able to keep their hand’ s position against the shoulder or exhibit any weakness. Izumi tested negative on the Bear Hug Test, which indicated that he did not have a subscapularis tear. The last test that was conducted was the Infraspinatus test, which determined the tear of the Infraspinatus. The patient’s arms will situate on their side while their elbows are flexed at 90 degrees. The healthcare provider will then place provide resistance onto the patient’s hand dorsum. The patient will be told to externally rotate both of their forearms. The patient will test positive if pain or weakness occurs during the external rotation. Izumi tested negative on this test which indicated that he does not have a tear in his Infraspinatus muscle. The doctor can conclude that Izumi has a possible massive tear of the supraspinatus tear on his left shoulder.

At Hospital pt.2

Diagnostic Tools

The doctor will use an X-ray and MRI to confirm the diagnosis. Izumi is experiencing excruciating pain which indicated that he needed to get an MRI. MRI is a great test to use when you’re trying to look for a rotator cuff tear. The MRI can be used to decipher the severity of the tear. MRI images are formed when it emits a magnetic field that causes the protons to position themselves with the field. The radiofrequency will echo through the affected area and the MRI is able to distinguish the energy. Before Izumi can get an MRI test done, he must first get an X-ray done to determine if there’s a chance that the excruciating pain is caused by other factors. X-ray images are created when x-rays pass through the affected area and the tissues take them in. The image’s contrast depends on the radiological density.

Diagnostic Tools

At Hospital pt. 3 (Videos)

Hornblower test: https://www.youtube.com/watch?v=KcNBtbVaatY

Drop Arm Test: https://www.youtube.com/watch?v=JXgRBeqToik&feature=emb_imp_woyt

Bear Hug Test: https://www.youtube.com/watch?v=b-dt3Hy4vD4&feature=emb_imp_woyt

At Hospital pt.3

Infraspinatus Test: https://www.youtube.com/watch?v=gPDN7XIA-KI&t=1s

The Rotator Cuff consists of 4 muscles: Supraspinatus, Infraspinatus, Teres Minor, and the Subscapularis. These group of muscles' tendons cover the humerus. They provide you the ability to rotate, extend, abduct, and adduct your humerus (arm). The rotator cuff muscle that Izumi injured is the supraspinatus. Izumi will have a difficult time abducting his humerus. Izumi's supraspinatus has a full thickness tear, which means that his tendon contains a hole.

Rotator Cuff

Bones and other Structures

• The Glenohumeral joint contains a rounded end that connects the humerus to the scapula. It's a ball and socket type of joint, which allows your arm to freely move around.
• The Acromioclavicular joint connects the scapula to the clavicle. Its function is to assist the scapula in gaining more range of rotation.
• The Bursa Sac is a capsule filled with fibrous fluid. It covers around a synovial joint, acting as cushion to reduce the friction between tendons, joint capsule, and bones.
• The Clavicle acts as a support to stabilize the shoulder.
• The Acromion’s job is to protect the glenoid cavity.
• The Humerus is our upper arm’s bone. It connects the scapula to the radius and ulna (lower arm).
• The Scapula is a triangular bone that stabilizes the shoulder joints. It is connected to the humerus and clavicle.

Bones and other structures

Surgery + Rehabilitation

Izumi will be asked to put on a gown and seat themselves in a comfortable position. Izumi is given the anesthetic and a sterile wash on his shoulder. The surgeon will evaluate Izumi's range of motion, relative stability of his joint, any grinding, or a catching of the joint. The surgeon will cut two small incisions (1cm) on his shoulder area. A canula is placed through the incision, and is irrigated with sterile saline. The joint will get filled with the clear liquid and allow the arthroscope to go through. The surgeon will insert an arthroscope through that incision. The arthroscope contains a small camera which will project the photos onto a screen. The screen will be used as a guide for the arthroscope. The surgeon will evaluate his shoulder again, but this time with the use of the arthroscope. The surgeon will test the integrity and stability of joints, any indication of ligament injuries, and any bone injuries. The surgeon will then begin their surgery by refashioning the supraspinatus tear using the 'margin convergence' technique. Two holes will be drilled into his humerus and suture anchors will be placed in them. The torn edge of the supraspinatus will be sewn through the suture. The surgeon will remove their arthroscope out and stitch up their incisions. Over time, tissues will grow over the suture and suture anchors. After the surgery, Izumi's shoulder will be placed in a sling so that his shoulder can have support and protection. Izumi will be given medication to assist with managing the pain. He will not be able to use his arm for 4-6 weeks. In the next 4-6 weeks, Izumi will receive passive exercises. Izumi's therapist will move his arm around in different positions. Izumi will be able to do active exercisings after 4-6 weeks. Izumi will not need his therapist's assistance any longer. After 8-12 weeks Izumi will be able to begin his strengthening exercise program.

Link if it doesn't work: https://www.youtube.com/watch?v=T8SWKH18FIQ

Surgery + Rehabilitation