Musckoloskeletal-Shoulder and Elbow Flashcards
Clavicle Fracture
-Tx: conservative-sling, immediate ROM
-Operative-gross displacement, skin integrity jeopardized
-Complications-brachial plexus injury, associated PTX or vascular injury, nonunion
Scapula Fracture
-Uncommon
->85% with associated injuries; high energy trauma
-many times found on chest CT.
TX
-Conservative – sling, immediate ROM
-Operative-intraarticular
large displacement
-Complications-Pneumothorax
Pulmonary contusion
Vascular injury
Brachial plexus injury
Proximal Humerus Fracture
-Most common humeral fracture
-May be related to OSA
-May heal well
-Early ROM is key to regaining function
-Exam: extreme shoulder pain w/ movement
TX
-Conservative – 1 or 2 part fracture - shoulder immobilizer
-Operative-2 part – shoulder immobilizer or ORIF
3 or 4 part – ORIF or hemiarthroplasty
-Complications: Stiffness, avascular necrosis, nonunion
Humeral Shaft Fracture
-Most treated non-operatively in coaptation splint
-May be site of pathologic fracture
-Assess for radial nerve palsy
-Almost 100% heal
-Exam: Deformity, Radial Nerve Exam
TX
-Conservative – most humeral shaft fractures Coaptation splint, Sarmiento brace
-Operative-ORIF vs Nail
-Complications: Radial nerve injury
Rotator Cuff Injury
-Supraspinatus is most common
-EXAM: decreased ROM, + drop arm/empty can test-supraspinatus, + lift off-subscapular, Weakness or pain with external rotation-infraspinatus/teres minor
-Tx: NSAIDs, Physical Therapy.
-Operative-rotator cuff repair
Dislocation
-Anterior most common-Hills Sachs-injury to humeral head and Bankart (labral tear) lesions
-Can recur
-Posterior-after seizure
-Inferior/Superior-Very rare
-Exam: deformity, flattened shoulder, neurovascular exam
Treatment of Dislocations
-Immediate reduction
-Pre and post reduction neurovascular exam
-Immobilize 2-6 weeks
-Operative-recurrent dislocations
-Complications: Recurrence, axillary nerve injury, rotator cuff tear, fracture
Acromioclavicular Separation (AC)
-More common in males
-Contact sports-football
-Exam: Pain at AC joint, deformity
-Tx: Conservative-sling for comfort, range of motion as tolerated.
-Operative-Reserved for >100% displacement or if clavicle is displaced posterior or inferior
-Complications-permanent deformity, stiffness
Bursitis/Impingement
-Exam: Inability to do overhead activities: + Neer, +Hawkins
-Tx: NSAIDs, Rest, Injections, Physical Therapy
-Operative-subacromial decompression
Olecranon Fracture
-Direct fall on elbow
-Triceps tendon pulls fragment
-Exam: Swelling/effusion, neurovascular exam-ulnar nerve
TX
-Splint in position of comfort on day of injury
Attempt to extend elbow
-Operative-Displaced, open, comminuted, unable to fire and extend arm against gravity
-Complications-ulnar nerve injury, stiffness
Olecranon Fracture
-Direct fall on elbow
-Triceps tendon pulls fragment
-Exam: Swelling/effusion, neurovascular exam-ulnar nerve
TX
-Splint in position of comfort on day of injury
Attempt to extend elbow
-Operative-Displaced, open, comminuted, unable to fire and extend arm against gravity
-Complications-ulnar nerve injury, stiffness
Radial Head Fracture
-Fall on outstretched arm-common
-Can be associated with elbow dislocation
-Exam: Wrist pain, decreased ROM-pronation/supination
TX
-Sling for comfort, Early ROM
-Operative-If displaced and over 1/3 of head involved
Open, Comminuted
Medial Epicondylitis; Golfers Elbow
-Overuse injury
-Exam: Medial elbow pain, + Golfer’s elbow test
Tx: NSAIDs, rest, ice, PT, steroid injections
-Operative: Surgical release of the tendon – not as effective as release of lateral epicondylitis
Lateral Epicondylitis; Tennis Elbow
-Overuse injury
-Exam: lateral elbow pain, worse with wrist and finger extension, + tennis elbow test
TX: NSAIDs, Rest, ICE, PT, Steroid injections
-Operative-surgical release of tendon
Olecranon Bursitis
-Inflammation of bursa
-Palpable mass at the olecranon
-Tx: Compression with ACE wrap, immobilization, DON’T ASPIRIATE
