UL:SHOULDER REGION FRACTURES, DISLOCATIONS AND PATHOLOGIES

Question 1

ANTERIOR SHOULDER DISLOCATION

Answer 1

MOA: abduction, extension and external rotation of the arm
Found in: motorcycle and sports injuries & elderly due to poor muscle control & falls

Complications:
Axillary nerve
Axillary artery
# of the greater tuberosity

Management:
Subluxation
Rest in a sling for 2/52. Start pendular exercises in the sling at 2/52 (1/52 in elderly).

Dislocation
Reduce ASAP, under anaesthetic if necessary. Maintain with arm sling for 2/52. Start pendular exercises at 2/52 (1/52 in elderly).

Post-Surgery:
Sling for 3 weeks before starting to wean.

Contra-indications and precautions:
Avoid abduction and external rotation positions for 6/52.
No contact sport for 6/52
No driving with a sling and only when pt can drive/handle steering wheel with control

Question 2

POSTERIOR SHOULDER DISLOCATION

Answer 2

Cause: fall on an internally rotated arm, seizures, electric shock

COMPLICATIONS
Recurrent dislocation that requires surgery.

MANAGEMENT
Reduction (under anaesthetic if necessary). The shoulder is then splinted in some abduction and external rotation.

Question 3

STERNO-CLAVICULAR DISLOCATION

Answer 3

CAUSE
Fall/blow to point of SH

DEFORMITY
Ant/post

COMPLICATIONS
Post= great vessels

MANAGEMENT
Minor: Symptomatic + sling
Major: Reduction and sling

Contra-indications and precautions
Avoid excessive pain.
Consult Dr regarding mobilisation protocol to be followed.

Question 4

FRACTURES OF THE CLAVICLE

Answer 4

CAUSE
Fall outstretched hand/blow on SH

CLASSIFICATION
Middle + distal

DEFORMITY

COMPLICATIONS
fibrosis-Irritation on the brachial plexus
Malunion
Associated SC or AC joint injuries
Management
A sling may be used for up to 7/52.
Surgical:
•When the brachial plexus or subclavian vessels are in danger.
•Plates or compression screws are usually used.
•Post surgery: Sling

Contra-indications and precautions
• Monitor circulation and sensation
•Avoid excessive pain
• Sling to be on as per Dr orders

Question 5

ACROMIO-CLAVICULAR INJURIES

Answer 5

CAUSE
Fall to the tip of the SH

CLASSIFICATION
Subluxations and sprains- damage to AC ligaments
Dislocations- complete tearing of the joint capsule, trapezoid & conoid lig

DEFORMITY

COMPLICATIONS
Severe haemotoma of the conoid and trapezoid ligaments may ossify, restricting
shoulder mobility

MANAGEMENT
Subluxations and sprains=Symptomatic treatment with a sling.
Dislocations=Can use a sling, or may need ORIF. ORIF does not usually yield a good result. Implants to be removed to gain full ROM.

Precautions and contra-indications
Similar to treatment of clavicular fractures.

Question 6

FRACTURE OF THE SCAPULA

Answer 6

CAUSE
Direct violence

CLASSIFICATION
Usually comminuted. Fracture may also be localized to the scapular neck.

DEFORMITY
Associated with severe bruising & swelling

COMPLICATIONS
Serious injuries such as pulmonary contusion or haemothorax

MANAGEMENT
-Sling and treated symptomatically
-Severely displaced fracture/younger patient=Patient may undergo closed reduction or ORIF. The sling routine postsurgery is as above.
-Elderly patient=Accept any deformity and sling for only 1/2/52. Then mobilize the
shoulder in a sling with pendular exercises.