Acute Traumatic Shoulder Injuries

X-ray Positive

1. Dislocation
2. Fracture
3. AC Injury
   1. Injury: Direct trauma, chronic
   2. Diag: Superior pain; pain adduction
      1. TypexxExam
      2. negFROM
      3. slight displace
      4. 3100% displaceclinc deform
      5. Rx:
         1. 1&2 --> sling, PMD, ROM ex after 2wks
         2. 3 --> sling, ortho x 2 dys, ?surg

X-ray Negativie

1. AC Injury, type 1 (see above)
2. Glenohumeral Instability
   1. -subluxation (separation) or dislocation (now reduced)
   2. -PE: pt holds arm close to body with unaffected hand
   3. Rx: F/U ortho
3. Rotator Cuff
   1. Injury: 90% chronic arms overhead
   2. Diag:
      1. result of extreme overuse in young adults (e.g. pitchers) or minor trauma in older adults
      2. sudden "pop" while lifting overhead
      3. lateral pain
      4. worse at night
      5. abduct arm pain after 20deg
      6. relief of pain w/ lido inject
      7. (pain free weakness = full tear)
   3. PE: -loss of active BUT NOT passive ROM (due to pain)
      1. -positive impingement signs
      2. -weakness with drop arm test
   4. Rx: Acute --> sling, PT, ortho f/u
      1. Chronic --> PT, ortho
      2. Next: MRI, surgery for younger pts with big tear, rehab
      3. PT: arm dangle at side, circle 5-10wt

Biceps Tendon Rupture

1. bulge in distal humerus (Popeye muscle), usually result of injury
2. PE: 20% loss of strength of supinators, 8% loss of strength of elbow flexors
3. next: surgery for younger pts, rehab

Source

8/07 DONALDSON (adapted from Miller, Mistry)