Shoulder Injuries Diagnosis & Treatment

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Shoulder InjuriesDiagnosis Treatment

• By
• Don Hudson, D.O., FACEP/ACOEP

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Shoulder Injuries what to consider

• Rotator Cuff Injury
• Anterior Dislocation
• Posterior Dislocation
• Clavicle Fracture
• Humerus Fracture
• Vascular Neurological Injuries
• Ligament injuries

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Most Common

• I will go over the most common injuries first.
• The anterior shoulder dislocation
• Clavicle fracture

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Anterior Dislocations

• These usually occur because of a forceful
  downward motion against resistance with the
  humerus up rotating
• An example is a lay-up shot in basketball that is
  blocked by a downward motion from another player.
• Of course any similar mechanism of injury will
  accomplish the same dislocation.

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Clavicle fractures

• These occur because of axial loading along the
  long axis of the clavicle
• Direct blow to the clavicle anterior to posterior
• Depending on the patients age it will fracture
  (in younger patients) in medial 1/3
• In older patients it usually fractures in the
  lateral 1/3

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Posterior Dislocations

• These usually occur because of a anterior to
  posterior motion, i.e. fall on an outstretched
  arm, motor vehicle accident, etc.
• These frequently have neurological complications.

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Ligament Injuries

• Ligament injuries are caused by normal motion
  taken beyond physiological limits
• Acute injuries swell, bruise hurt
• Chronic injuries defined by crepitence pain
  mainly because of scarring.
• Early ROM helpful to prevent chronic state
• ROM may decrease chronic pain

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Shoulder Anatomy
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More Shoulder Anatomy
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More Shoulder Anatomy
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Vascular Anatomy
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More Shoulder
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Potential Associated Injury
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Anterior Dislocations
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Posterior Dislocations
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Now what?

• Your worries are?
• Humerus Fracture
• Brachial Plexus injury
• Clavicle Fracture
• Isolated vascular injury

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The thought is to do no harm

• The reduction is done for pain relief.
• Also for improvement of vascular or neurological
  compromise
• The longer it is out of socket the longer
  rehabilitation will take
• Lots of soft tissue ischemia is occuring

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Reductions

• There are a lot of techniques available.
• The two that are the least traumatic are the
  scapular rotation and lifting of the arm.
• The lifting procedure takes 2 fingers.
• The scapula rotation is a little more
  complicated.

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Anesthesia

• This can range for none to general depending on
  the patient.
• Develop good rapport with them and explain the
  process and the amount of time when pain will be
  high.
• Most choose no pain meds.

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Anesthesia

• When I use it I prefer a local joint block with
  5-8 cc of a ½ Marcaine Lidocaine either with or
  with out epi.
• IV meds include MS, Fentenyl, Valium, Versed,
  Ketamine or Demerol.
• Consider how long it takes to recover and how
  long they may be in the ER/clinic.

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PRACTICE SESSION

• Traction counter traction techniques
• SAGER technique (why not to use)
• Scapular Rotations
• Humeral lift techniques
• What to do if these do not work, what do you
  consider the reason how do you correct it.

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Problems Rehabilitation

• These take a while to heal tighten up
• 4-6 weeks is average.
• Repeated subluxations frequently need surgery
• Narcotics rarely needed unless a complicated
  reduction or other issues of trauma needs to be
  considered