View source for Acute Traumatic Shoulder Injuries

==X-ray Positive==


0.  Dislocation

1.  Fracture

 

2.  AC Injury

Injury:  Direct trauma, chronic

Diag:  Superior pain; pain adduction

     TypexxExam

     1negFROM

     2slight displace

     3100% displaceclinc deform

Rx:

     1&2 --> sling, PMD, ROM ex after 2wks

     3 --> sling, ortho x 2 dys, ?surg

 

==X-ray Negativie==


1.  AC Injury, type 1 (see above)

 

2.  Glenohumeral Instability

-subluxation (separation) or dislocation (now reduced)

-PE: pt holds arm close to body with unaffected hand

Rx:  F/U ortho

 

3.  Rotator Cuff

Injury: 90% chronic arms overhead

Diag:

     -result of extreme overuse in young adults (e.g. pitchers) or minor trauma in older adults

     -sudden "pop" while lifting overhead

     -lateral pain

     -worse at night

     -abduct arm pain after 20deg

     -relief of pain w/ lido inject

     (pain free weakness = full tear)

PE: -loss of active BUT NOT passive ROM (due to pain)

-positive impingement signs

-weakness with drop arm test

Rx:  Acute --> sling, PT,  ortho f/u

Chronic --> PT, ortho

Next: MRI, surgery for younger pts with big tear, rehab

PT:  arm dangle at side, circle 5-10wt

 

4.  Biceps Tendon Rupture

-bulge in distal humerus (Popeye muscle), usually result of injury

-PE: 20% loss of strength of supinators, 8% loss of strength of elbow flexors

-next: surgery for younger pts, rehab

 

==Source==


8/07  DONALDSON (adapted from Miller, Mistry) 




[[Category:Ortho]]