how does an anterior shoulder dislocation present
signficant pain in the shoulder
arm is adducted and externally rotated
feeling of instability and limited mobility
what investigations are appropriate for a shoulder dislocation
XR
if soft tissue injury is suspected MRI
testing of axillary nerve and neurovascular status
test nerve and XR again after reduction
what is the management for a shoulder dislocation
reduction, immobilisation and rehabilitation
closed reduction should be done
use of a broad sling
tend to be immobilised for around 2 weeks
what are bony bankart leisions
fractures of the anterior inferior glenoid bone, most commonly present in those with recurrent dislocations
what are hillsach leisons
impaction injuries to the chondral surface of the posterior and superior portions of the humeral head
present in approximately 80% of traumatic dislocations
what complications can occur from shoulder dislocation
chronic pain
limited mobility
stiffness
recurrent dislocation
post-traumatic OA
why are anterior dislocations the most common
the inferior glenohumeral ligament is the main support of the anterior glenoid humeral joint
which is the weakest ligament of the shoulder
what are the most common causes of clavicle fractures
FOOSH in children
traumatic deliveries
- in infants a sign may be they are not playing with that arm
or direct blows from contact sports
how do the fragments of a clavicle # move
tend to be mid clavicular #
medial fragment moves upwards due to SCM
lateral fragment moves inferior medially this is due to trapezius being unable to support the limb and due to pec major adducting
what complications can come from clavicle #
pneumothorax
neurovascular injury (supra clavicle nerve and subclavian artery)
ensure to advise to return if any changes to sensation
what is the grading system for clavicle fractures
Allman classification system
Type I: middle third of the clavicle, (as the middle third is the weakest segment)
They are generally stable, although significant deformity is usually present
Type II – lateral third
When displaced, this type are often unstable
Type III –medial third of the clavicle, commonly associated with multi-system polytrauma
As the mediastinum sits directly behind the medial aspect of the clavicle, they can be associated with neurovascular compromise, pneumothorax, or haemothorax
what is the management of a clavicle fracture
XR to assess displacement
without significant deformity can be treated with a sling and physio, early mobilisation can help prevent frozen shoulder
All open fractures will need surgical intervention.
Where fractures have failed to unite, an open-reduction internal-fixation (ORIF) will be necessary, which is usually performed at 2-3 months post-injury.
how do rotator cuff tears present
progressive loss of mobility rather than pain
if acutely developed however they also often have pain too
Hx of repetitive overhead use
acute - Hx sporting/ high speed injury
which is the most commonly torn rotator cuff tear
supraspinatus
what is the management of rotator cuff tears
XR to confirm - can sometimes have superior humeral head migration due to deltoid action
MRI/CT to assess size and thickness of tear
rest, analgesia and physio
children may tolerate surgery due to better blood supply
what is a supraspinatus tear sequelae
hydroxyapatite crystals can become deposited over time
pain is felt when crystals are re-absorbed
during this treat with NSAIDs, or steroid/ local anaesthetic injections
long term supraspinatus decompression however condition is generally self limiting
what is shoulder impingement
subacromial impingement syndrome
inflammation of the tendons as they pass through the the subacromial space
what can cause shoulder impingement
inflammation of supraspinatous tendon
Subarcromial bursitis
Subacromial osteophytes
Management of shoulder impingement
Physiotherapy
Steroid subacromial space injections
Surgical repair -?
What is frozen shoulder
Adhesive Capsulitis
Chronic condition - thickening and contraction of the glenohumeral joint capsule and formation of adhesions
Shoulder pain and stiffness which progresses to restricted range of movements and severe pain
Risk factors of frozen shoulder
F>M
DM
CVD
Thyroid disease
Connective tissue disease
Breast cancer
What are the management options for adhesive capsulitis
Self limiting condition, while monitoring prescribe analgesia and physio
Intra-articulate steroid injections or distension therapy (injecting saline)
Surgical - manipulation and arthroscopic capsular release
Which shoulder joints can be affected by OA
Acromioclavicular
Glenohumeral joint
