Shoulder Trauma

Question 1

Importance of the clavicle

Answer 1

Only bone attaching your arms to your torso

Question 2

Clavicle fractures

• mechanism of injury
• common in
• location
• management

Answer 2

FOOSH, fall onto shoulder
Young, active males

Middle 1/3

Depends on

• location of fracture
• soft tissue involvement
• associated injuries
• neurovascular damage (subclavian vessels, brachial plexus)

Non operative - broad arm sling
-must support the elbow to prevent weight of arm pulling clavicle away
Operative - open reduction internal fixation
-esp if open/additional injuries

Question 3

Clavicle fracture considerations

Answer 3

Neonates at birth => potential brachial plexus injury
-but generally heal well

Middle 1/3 fractures
-comminution => significant displacement

Lateral 1/3 fractures
-high rate of nonunion esp if coracoclavicular ligament ruptures => can penetrate soft tissue and skin

Question 4

Proximal humerus fracture

• common in
• location
• presentation
• management

Answer 4

Elderly women, osteoporosis (ASK ABOUT BONE PROTECTION)
FOOSH

Surgical neck
-can be associated with dislocation

Pain
Can present with bruising and swelling in elbow and hand due to gravity pulling blood and fluid down

Non operative
-collar and cuff/high arm sling

Operative - open reduction internal fixation

• open/neurovascular injury
• displacement
• avascular necrosis risk

Question 5

Proximal humeral fracture

-potential areas and patterns of damage

Answer 5

Greater tuberosity moves up => supraspinatus
Shaft moves medially => pec major
Lesser tuberosity moves medially => subscapularis

Circumflex arteries surrounding humeral head can be torn => risk of avascular necrosis

Damage to brachial plexus

Question 6

Shoulder dislocation

• common in
• cause of injury
• types and associations
• presentation
• imaging findings
• management

Answer 6

Acute common shoulder injury
-young male with high recurrence

Anterior - more common
Posterior - associated with seizures
-both can be associated with axillary nerve palsy or humeral fracture

Loss of normal contour of shoulder
Pain

Post dislocation - lightbulb sign

Non operative - closed reduction/MUA
Operative - open reduction

Question 7

Biceps tendon injury

-pathophysiology

Answer 7

Long head tendon ruptures by attrition => popeye sign