17- Trouma & ER Explains 2 Flashcards
What are the types of dislocations around the shoulder joint?
Glenohumeral dislocation, acromioclavicular joint disruption, and sternoclavicular dislocation (only glenohumeral dislocation will be covered here)
What is the initial management required for shoulder dislocation?
Emergent reduction to prevent lasting chondral damage
What imaging modalities are used to confirm the direction of dislocation in shoulder dislocation?
True anteroposterior (AP), axillary lateral, and/or scapula Y view
What should be assessed during the early assessment and management of shoulder dislocation?
Careful history, examination, and documentation of neurovascular status of the limb, particularly the axillary nerve; this should be reassessed post-manipulation
What is the recommended technique for emergent closed reduction of shoulder dislocation?
Gentle traction to adducted arm under entonox and analgesia, often requiring conscious sedation
What should be done after successful reduction of shoulder dislocation?
The arm should be immobilized in a polysling, and X-rays should be taken to confirm relocation
What are the features and causes of anterior shoulder dislocation?
Usually traumatic with an anterior force on the arm when the shoulder is abducted and externally rotated; loss of shoulder contour (sulcus sign), and the humeral head can be felt anteriorly
What are the features and causes of posterior shoulder dislocation?
50% missed in A&E; 50% traumatic, but classically associated with seizures or electrocution; the shoulder is locked in internal rotation, and X-rays may show a lightbulb appearance
What are the features and causes of inferior shoulder dislocation?
Rare; associated with pectoralis and rotator cuff tears, and glenoid fracture; similar to the management of the primary injury
What are the features and causes of superior shoulder dislocation?
Rare; associated with acromion/clavicle fracture; similar to the management of the primary injury
What is rotator cuff disease?
A spectrum of conditions ranging from subacromial impingement to rotator cuff tears and eventually to rotator cuff arthropathy (arthritis)
What are some associated injuries seen with shoulder dislocation?
Bankart lesion (avulsion of the anterior glenoid labrum), Hill Sachs defect (chondral impaction on posteriosuperior humeral head), rotator cuff tear, greater or lesser tuberosity fracture, and humeral neck fracture (should be discussed with orthopaedics prior to any attempted reduction)
What is the function of the rotator cuff muscles?
Important in shoulder movements and maintenance of glenohumeral stability
What are the four muscles of the rotator cuff?
Supraspinatus, Infraspinatus, Teres Minor, and Subscapularis
Which muscle is responsible for the external rotation of the humerus?
Infraspinatus and Teres Minor
Which muscle is involved in the internal rotation of the humerus?
Subscapularis
Which nerves innervate the rotator cuff muscles?
Suprascapular nerve (Supraspinatus and Infraspinatus), Axillary nerve (Teres Minor), Upper and Lower Subscapular nerves (Subscapularis)
What happens when there is an injury or tear in the inferior rotator cuff muscles?
Upward migration of the humeral head on the glenoid can be seen on an AP radiograph
How do the anterior muscles (subscapularis) and posterior muscles (infraspinatus, teres minor) of the rotator cuff balance each other?
The anterior muscles are balanced with the posterior muscles to maintain shoulder stability
What is subacromial impingement?
The most common cause of shoulder pain resulting from impingement of the superior cuff on the undersurface of the acromion, along with inflammatory bursitis
What is the presentation of subacromial impingement?
Insidious pain exacerbated by overhead activities
Which type of acromial morphology is associated with subacromial impingement?
Certain types of acromial morphology (Bigliani classification)
What is a rotator cuff tear?
Often presents as an acute event on the background of chronic subacromial impingement in older patients, and as an avulsion injury in younger patients
Which part of the rotator cuff is commonly affected by tears?
The majority of tears occur in the superior cuff (supraspinatus, infraspinatus, teres minor), although a tear to subscapularis is associated with subcoracoid impingement