Shoulder Injuries Flashcards
What is the most common shoulder dislocation?
Anteroinferior
How does an anterior dislocation occur?
Force applied to an extended, abducted and externally rotated humerus
How does a posterior dislocation occur?
Seizures, electrocution, trauma (direct blod to the anterior shoulder or force through a flexed arm)
What are the clinical features of a shoulder dislocation
Painful shoulder, reduced mobility and a feeling of instability
What would you see on examination of a dislocated shoulder?
Asymmetry, loss of shoulder contours (flattened deltoid) and an anterior bulge from the head of the humerus.
Important to assess NV status
What are some bony injuries associated with shoulder dislocation?
Bony BAnkart - fractures of the anterior inferior glenoid bone
Hill-Sachs - impaction injuries to the chondral surface of the posterior and superior portions of the humeral head
Fractures of the greater tuberosity and the surgical neck of the humerus (below the lesser tuberosity)
What are some ligament injuries associated with dislocation?
Soft Bankart lesions - avulsions of the anterior labrum and inferior glenohumeral ligament
Glenohumeral ligament avulsion
Rotator cuff injuries due to anterior dislocation in younger patients
What investigations are required for a dislocation?
Plain radiograph trauma series - AP view, Y-scapular view and axial view
What does the light bulb sign indicate?
Posterior dislocation
How should a shoulder dislocation be managed?
A-E assessment - stabilise and analgesia
Reduction
Hold - immobilisation
Rehabilitation
Closed reduction, e.g. Hippocratic method should be performed by a trained specialist
Assess NV status
Failed closed reduction may warrant manipulation under anaesthesia in theatres
Once reduced, place arm in a broad-arm sling.
2 weeks for anterior dislocation
Physiotherapy to restore range of movement, functionality and strengthen the rotator cuff and pericapsular muscles
Surgical treatment for recurrent pain, instability, Hill-Sachs/Bankart lesions
What are complications of shoulder dislocation?
Chronic pain, limited movement, stiffness, recurrence, adhesive capsulitis, nerve damage, rotator cuff injury, degenerative joint disease
Where does a proximal humerus fracture occur?
Through the surgical neck
Rare to have fractures through anatomical neck - however displaced anatomical neck fractures risk avascular necrosis to the humeral head
How are surgical neck fractures managed?
Collar and cuff for 3 weeks followed by physiotherapy
Open reduction and internal fixation for more significant displaced fractures
Damage to what muscle causes an inability to initiate abduction?
Supraspinatus
suprascapular nerve C5, C6
What is supraspinatus tendonitis?
Rotator cuff injure - subacromial impingement - painful arc
Painful arc of abduction between 60 and 120 degrees, tenderness over anterior acromion
