Shoulder Trauma Flashcards
common U/E fractures, particularly in patients older
than 65 years
Proximal humeral fractures
most are isolated and stable
70% of proximal humeral fractures occur in
women due to osteoporosis
If displaced fracture is present, it increases chances of
AVN of the Humeral Head
used for radiologic-clinical correlation and the severity of
the proximal humeral fractures
Neer classification
physeal lines that divide proximal humerus
into four parts:
1) the head
2) the greater tuberosity
3) the lesser tuberosity
4) surgical neck and/or the proximal shaft
As defined by Neer in 1970, fragments are considered displaced if there is
> 1 cm of separation and/or >45-degrees of angulation of a fragment
(Most fractures are minimally or un-displaced (80% to 85%)
80 % of proximal humeral fractures are
minimally displaced
One-part Neer fracture
No fragments displaced (80%)
Two-part Neer fracture:
One fragment displaced >1cm or 45-degrees (13%)
Three-part Neer fracture:
Displacement of the surgical neck and either the greater
or lesser tuberosity (3%)
Four-part Neer fracture:
Typically displaced fractures of both tuberosities and surgical neck (4%)
Un-displaced fractures (Neer one-part) should be treated
conservatively (e.g. sling)
lucent line and cortical breach with variable degrees of
cortical off-set, angulation, impaction and displacement
Proximal humeral fractures
most common Neer two-part fracture
Surgical neck fracture
may occur from
Pectoral pull during surgical neck or proximal metaphysis fractures
medial
displacement of proximal fragment
Some sources may refer to greater tuberosity Fx as
“Flap
Fracture”
Shoulder dislocations
1) Anterior GH dislocation (most common)
2) posterior GH dislocation
3) inferior GH dislocation (Luxatio Erecta)
most common shoulder dislocation
subcoracoid Anterior GH
Anterior shoulder dislocation usually results from
forced abduction, external rotation and extension
protective falls
inferior GH dislocation, also known as?
Luxatio Erecta
anterior shoulder dislocation mostly occur to
young men with high-energy injuries
types of Anterior dislocations
subcoracoid: most common
subglenoid
subclavicular
intrathoracic: very rare
anterior dislocations of the humeral head comes to lie
anterior, medial and
somewhat inferior to its normal location and glenoid fossa
complications of anterior shoulder dislocations?
Hill-Sachs deformity/impaction Fx and Bankart lesion
Kocher’s manoeuvre can be
performed by
traction and external rotation and then adduction and
internal rotation.
dislocation treatment for patient under 40
3-weeks of collar and a cuff shoulder
immobilization
dislocation treatment for older patient
collar and a cuff are applied for 48-hours followed by
some attempts to mobilize the shoulder.
Posterolateral humeral head impaction fracture as the humeral head pressed against the antero-inferior part of the glenoid
Hill-Sachs lesion
Hill-Sachs lesion is often associated with a
Bankart lesion of the glenoid
When a Hill-Sachs lesion is identified careful assessment of the anterior glenoid rim should be performed to search for potential
Bankart lesion
Hill-Sachs impaction is best appreciated following relocation
of the joint especially on what view?
internal rotation view
sclerotic vertical line extending from the top of the humeral
head towards the shaft
Hill-Sachs lesion (wedge defect may be noted)
the wedge defect sometimes found with Hill-Sachs lesions is also called a?
“hatchet deformity”
common complication of anterior shoulder dislocation and
is frequently seen with Hill-Sachs impaction deformity
Bankart lesion (may heal spontaneously)
Bankart lesion associated with detachment of the
anterior inferior labrum
from the underlying glenoid
bankart lesion, labral only
“cartilagenous Bankart”
bony bankart with…
detached fragment of inferior glenoid rim
less common than anterior and sometimes hard to identify if only AP projections are obtained
Posterior shoulder dislocation (PSD)
Posterior shoulder dislocation (PSD) accounts for what % of all shoulder dislocations?
2-4%
mechanism of Posterior shoulder dislocation (PSD)
Humeral head is forced posteriorly in internal rotation whilst the arm is being
abducted
most common cause of Posterior shoulder dislocation (PSD)
Convulsive disorder (epilepsy)
known classic but rare cause of posterior shoulder dislocation
Electrocution
the preferred view for diagnosis of posterior shoulder dislocation
axillary view
absence of what on radiographs is a major clue to posterior shoulder dislocation?
Absence of external rotation of the humeral head on images in a standard shoulder series
internally rotated humeral head takes on a rounded appearance
Light bulb sign
vertical dense line in medial humeral head indicating impaction by the posterior glenoid
Trough sign
with trough sign there will be Loss of normal
semilunar overlap sign on frontal views
widened glenohumeral joint > 6 m (important)
RIM SIGN
inferior shoulder dislocation is also known as ________ ,
luxatio erecta
inferior shoulder dislocation is also known as luxatio erecta because the arm appears to be
permanently held in fixed in an abducted position
inferior shoulder dislocation is caused by a
hyperabduction/inferior push of the arm
inferior shoulder dislocation is caused by a
hyperabduction/inferior push of the arm
in inferior shoulder dislocation the humeral head is displaced directly below, and a little _____ to the glenoid
medial
Inferior dislocations have a high or low complication rate
high
ACJ injuries usually occur from a _______ or following a fall onto the shoulder with an _______ arm.
direct blow, adducted
ACJ injuries are uncommon.
True or false?
false
AP and cephalad angled (10-15 degree) view with and w/o weights (10lb)
are obtained for?
ACJ injury
Surgical intervention on a grade __ ACJ injury should be considered
lll
Features of ACJ injury include:
- soft tissue swelling
- widening of the AC joint
- increased coracoclavicular (CC) distance
- superior displacement of the distal clavicle
may be the only finding in grade I ACJ injuries
soft tissue swelling
normal ACJ space is?
5-8 mm (narrower in the elderly)
normal coracoclavicular (CC) distance is?
10-13 mm
Normally the undersurface of the acromion should be leveled with the
undersurface of the
clavicle
Classification commonly used for the radiographic-clinical grading of ACJ
injury?
Rockwood
Type I Rockwood ACJ injury
AC ligament is sprained
everything else is normal
Type II Rockwood ACJ injury
- AC ligament is RUPTURED
- CC ligament: sprain
- joint capsule: ruptured
- deltoid muscle: minimally detached
- trapezius muscle: minimally detached
- clavicle elevated but not above the superior border of the acromion
Type IIl Rockwood ACJ injury
A- C & CC ligaments are RUPTURED
- joint capsule: ruptured
- deltoid muscle: detached
- trapezius muscle: detached
- clavicle elevated above the superior border of the acromion
Which types of Rockwood ACJ injuries can be treated conservatively?
1 and 2
Humeral shaft fractures account for ____ % of all fractures
3-5
2-age groups for humeral shaft fracture?
males in their 30’s and patients over 65
Direct blow to the upper arm usually causes a?
transverse fractures
The most common associated injury during Humeral shaft fractures is damage to the
radial nerve in the spiral groove
In some cases of a spiral fracture of the humeral shaft its distal fragment may be
displaced in such way that its proximal end will be displaced in what direction?
radially (i.e.
laterally)
when spiral fracture of humeral shaft causes radial displacement of proximal end, this is called a?
Holstein-Lewis Fx
Holstein-Lewis Fx may lead to damage to the
Radial nerve as it passes in the intermuscular
septum
location of 30% of Humeral Shaft Fractures
proximal third
60% of Humeral Shaft Fractures occur where?
middle third
10% of Humeral Shaft Fractures occur where?
distal third
most common humeral shaft fractures occur where?
middle third
