shoulder girdle fractures Flashcards
where is the most likely location of a clavicle fracture & why?
the middle 1/3 as it is the thinnest
what joint injuries can a clavicle fracture be associated with?
-AC joint injury
-SC joint injury
what are the 3 main MOI’s of a clavicle fracture?
-fall with arm out, onto hand
-fall onto shoulder
-direct blow to shoulder
what are the complications of a clavicle fracture?
-malunion or deformity
-damage to blood vessels
-non union
-if fractured in a downward direction, it could damage a lung
how is an undisplaced clavicle fracture treated?
-broad arm sling for 2-3 weeks MAX (as we don’t want shoulder joint to get stiff)
-must provide support for the weight of the arm
-sling needed for comfort only
-try to get shoulder moving ASAP
how is an displaced clavicle fracture treated?
-ORIF & sling
-longer period of immobilisation which is guided by orthodox doctor
what are the causes of an AC joint injury?
blow to the shoulder in a downward force eg rugby or hockey
how many grades of an ACJ injury are there?
1-6
upon examination, what might you notice with an ACJ injury?
-tenderness
-palpable step (deformity)
-arm may look longer
-AP x ray
what are the 2 main MOI’s of an ACJ injury?
-fall onto the point of the shoulder
-fall onto outstretched hand with the humerus in an adducted position
what is the classification of an AC joint injury called?
Rockwood classification
Describe a grade 1 ACJ injury
- sprain of the capsule
-localised tenderness and pain on horizontal flexion (flexion across body)
Describe a grade II ACJ injury
-complete tear of the AC ligaments with sprain of the coracoclavicular ligaments (conoid & trapezoid)
-localised tenderness, pain on mat and palpable step deformity (but might not see it)
Describe a grade III ACJ injury
- complete tears of the AC ligaments and CC ligaments
-marked step deformity and pain on mat
describe a grade IV-VI ACJ injury
-complete rupture of all ligament complexes and dislocation of the joint
-pain, loss of mvt & function
what is a very specific special test for AC joint injury?
the scarf test
is there a loss of ROM seen with ACJ injuries?
yes
how are ACJ injuries managed (GRADE1-6)
- grade I & II are treated conservatively
-grade III - surgical vs conservative - there is an ongoing debate about this
-grade IV, V 7 VI are treated surgically
what does conservative management of grade I & II ACJ injuries involve?
-advice 7 education
-reduce pain - ice, period of immobilisation in sling ( 2-3 days in grade 1 & up to 6 weeks with grade II)
-joint and ST manual therapy
-isometric exercises may commence as pain permits
-muscle strength, endurance and proprioception
-avoid horizontal pressing motions - will irritate the joint
how long are you in a sling for with a stable vs unstable ACJ injury for?
- stable - sling 4-6 weeks, commence ROM after this
-unstable- ORIF, sling and body bandage 4-6 weeks
describe an anterior SC joint dislocation- is it common?, MOI, treatment
-uncommon
-fall on hand
-high energy force
-treatment includes reduction, sling for 2-3 weeks and may need ORIF and brace for 4-5 weeks
describe a posterior dislocation of SC joint
rare but more serious
treatment includes ORIF
What is the cause of a fractured scapula?
usually direct violence
what does the treatment of a fractured scapula involve?
-broad arm sling of 2-4 weeks
-followed by ROM and physio
