Disorders and Injuries of the Shoulder part 1 Flashcards
What is the MC mechanism of injury for an Acromioclavicular joint
Direct force
Falls on AC joint with arm at side or collision sports
What is a Type I AC joint separation?
Sprain of Acromioclavicular ligament
AC joint is intact
Corococlavicular joint is intact
Pain w/o any deformities
what is a Type II AC joint separation
AC joint is disattached
Sprain of the corococlavicular ligament
Pain & deformity
What is a Type III AC joint separation?
Both AC ligament and Corococlavicular ligaments are disattached
AC join dislocated and shoulder is displaced inferiorly
Pain w/ deformity
What special tests can be used to assess an AC joint injury
Traction test
Cross arm Adduction test
Neers test
Modified Hawkins Kennedy test
Which test is the best to assess AC joint injury
Cross arm Adduction test
What are treatment options for Type I & II AC joint injuries
Non-operative is the standard of care
Ice and protection for 7-10 days
Return to sport or activity in 1-3 weeks
What is generally a non-operative treatment for Type III AC joint injuries?
Sling for 10-14 days
Return to activity in 3-4 weeks
When would surgery be appropriate for a Type III AC joint injury?
When would surgery be contraindicated?
- Throwing sport
- Overhead worker
Contraindicated in someone who plays contact sports due to risk of re-injury
What are complications that can arise from AC joint injuries?
Clavicular osteolysis
Acromioclavicular Osteoarthritis
How are osteolysis and osteoarthritis treated with AC join injuries?
Surgical resection of the affected bones
Which location by far is the most common location of a clavicular fracture?
Midshaft of the clavicle
What makes up the Allmans classifications for clavicular fractures?
Group 1 ==> Midshaft
Group 2==> Lateral portion of the clavicle
Group 3 ==> Medial portion of the clavicle
What are possible mechanisms of injury for a clavicular fracture?
Direct fall with arm at side
Direct blow
FOOSH
Upon inspection what things would you expect to see with a clavicular fracture?
Grinding with active ROM
Deformity at the midshaft
What findings would you expect to feel during palpation of a clavicular fracture?
Crepitus and tenderness
What must always be done when assessing a clavicular fracture during exam?
Why?
Neurovascular and Lung ascultations
Need to assess for brachial plexus injuries
Need to assess for subclavian vessels
What x-ray views are need to assess a clavicular fracture?
Which is gives the best view?
AP
Cephalic Tilt view ==> more sensitive at detecting fracture
What kind of treatment should be done for clavicular fractures?
NON-OPERATIVE
What are non-operative treatment choices for clavicular fractures?
Sling
Figue 8 sling
BOTH WORK JUST FINE
What are definitive reasons to surgically correct clavicular fractures
- Open fracture
- Tenting (yellowing for broken blood vessels
- Neurovascular injury - Brachial plexus
What are other relative reasons for surgical treatment of a clavicular fracture?
Widley displaced fracture
Displaced lateral 1/3 fracture ==> Takes too long to heal on its own
Multiple fracture segments
Dominate extremity in overhead athletes
Which type of shoulder dislocation is often MC
Anterior dislocation
What are the causes of a shoulder displacement
Traumatic
Non-traumatic - seizures
What are common etiologies for a posterior shoulder displacement?
Seizures
Electrical shocks
What type of fracture has a higher prevalence during a posterior shoulder displacement?
Lesser tuberosity fractures
What limitations do patietns with posterior shoulder injuries have?
Arm is abducted
Cannot externally rotate arm
What is the mechanism of injury for a anterior displaced shoulder?
Abduction or
External Rotation
What complications can occur with an anteriorly displaced shoulder?
Brachial plexus injury
How does someone with an anterior shoulder dislocation present?
Flattened deltoid
Fullness to the chest (humeral is stuck in there)
Prominent Acromion
Guarding
What exam needs to done before reducing an anteriorly displaced shoulder?
Neurovascular exam (brachial plexus injury?)
What views need to be taken for a anteriorly displaced shoulder
AP view
Axillary view
Y-view (plain of the scapula)
What exams are used to assess a shoulder dislocation?
Apprehension (pushes humeral head anteriorly during ER)
Jobe Relocation
Surprise
Sulcus sign
What is a Bankart Lesion?
Dettachment of the anterior and inferior portion of the labrum from the glenoid
What is the most common cause a instability with an anteriorly displaced shoulder?
Bankart lesion
What is Hill-sachs lesion?
Posterior lateral compression fracture of the humeral head
Prior to reduction what drug is given to sedate patients?
Fentanyl
What reduction techniques are used to reduce anteriorly displace shoulders
Hippocratic (pulling one direction with towel in the other)
Stimson (sling)
Hennipen technique (abduct arm and externally rotate)
What after care can be given after reduction of a displaced shoulder? What must the patient continously do while healing
Sling
Must extend elbow several times daily to prevent elbow stiffness
What age group is most likely to have reoccurring shoulder displacements and why?
Age <30
Due to high rates of Bankart lesions
