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

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

8/07 DONALDSON (adapted from Miller, Mistry)

Authors: