Shoulder InjuriesShoulder InjuriesDiagnosis & TreatmentDiagnosis & Treatment

ByBy

Don Hudson, D.O., FACEP/ACOEPDon Hudson, D.O., FACEP/ACOEP

Shoulder Injuries & what to considerShoulder Injuries & what to consider

• Rotator Cuff InjuryRotator Cuff Injury

• Anterior DislocationAnterior Dislocation

• Posterior DislocationPosterior Dislocation

• Clavicle FractureClavicle Fracture

• Humerus FractureHumerus Fracture

• Vascular & Neurological Injuries Vascular & Neurological Injuries

• Ligament injuriesLigament injuries

Most CommonMost Common

• I will go over the most common I will go over the most common injuries first.injuries first.

• The anterior shoulder dislocationThe anterior shoulder dislocation

• Clavicle fractureClavicle fracture

Anterior DislocationsAnterior Dislocations

• These usually occur because of a forceful These usually occur because of a forceful downward motion against resistance with downward motion against resistance with the humerus up & rotatingthe humerus up & rotating

• An example is a lay-up shot in basketball An example is a lay-up shot in basketball that is blocked by a downward motion that is blocked by a downward motion from another player.from another player.

• Of course any similar mechanism of injury Of course any similar mechanism of injury will accomplish the same dislocation.will accomplish the same dislocation.

Clavicle fractures Clavicle fractures • These occur because of axial loading along These occur because of axial loading along

the long axis of the claviclethe long axis of the clavicle

• Direct blow to the clavicle anterior to Direct blow to the clavicle anterior to posteriorposterior

• Depending on the patients age it will Depending on the patients age it will fracture (in younger patients) in medial 1/3fracture (in younger patients) in medial 1/3

• In older patients it usually fractures in the In older patients it usually fractures in the lateral 1/3lateral 1/3

Posterior DislocationsPosterior Dislocations

• These usually occur because of a These usually occur because of a anterior to posterior motion, i.e. fall anterior to posterior motion, i.e. fall on an outstretched arm, motor on an outstretched arm, motor vehicle accident, etc.vehicle accident, etc.

• These frequently have neurological These frequently have neurological complications.complications.

Ligament InjuriesLigament Injuries

• Ligament injuries are caused by normal Ligament injuries are caused by normal motion taken beyond physiological limitsmotion taken beyond physiological limits

• Acute injuries swell, bruise & hurtAcute injuries swell, bruise & hurt

• Chronic injuries defined by crepitence & Chronic injuries defined by crepitence & pain mainly because of scarring.pain mainly because of scarring.

• Early ROM helpful to prevent chronic Early ROM helpful to prevent chronic statestate

• ROM may decrease chronic painROM may decrease chronic pain

Shoulder AnatomyShoulder Anatomy

More Shoulder AnatomyMore Shoulder Anatomy

More Shoulder AnatomyMore Shoulder Anatomy

Vascular AnatomyVascular Anatomy

More ShoulderMore Shoulder

Potential Associated InjuryPotential Associated Injury

Anterior DislocationsAnterior Dislocations

Posterior DislocationsPosterior Dislocations

Now what?Now what?

• Your worries are?Your worries are?

• Humerus FractureHumerus Fracture

• Brachial Plexus injuryBrachial Plexus injury

• Clavicle FractureClavicle Fracture

• Isolated vascular injuryIsolated vascular injury

The thought is to do no The thought is to do no harmharm

• The reduction is done for pain relief.The reduction is done for pain relief.

• Also for improvement of vascular or Also for improvement of vascular or neurological compromiseneurological compromise

• The longer it is out of socket the The longer it is out of socket the longer rehabilitation will takelonger rehabilitation will take

• Lots of soft tissue ischemia is Lots of soft tissue ischemia is occuringoccuring

ReductionsReductions

• There are a lot of techniques There are a lot of techniques available.available.

• The two that are the least traumatic The two that are the least traumatic are the scapular rotation and “lifting are the scapular rotation and “lifting of the arm.of the arm.

• The lifting procedure takes 2 fingers.The lifting procedure takes 2 fingers.

• The scapula rotation is a little more The scapula rotation is a little more complicated.complicated.

AnesthesiaAnesthesia

• This can range for none to general This can range for none to general depending on the patient.depending on the patient.

• Develop good rapport with them and Develop good rapport with them and explain the process and the amount explain the process and the amount of time when pain will be high.of time when pain will be high.

• Most choose no pain meds.Most choose no pain meds.

AnesthesiaAnesthesia

• When I use it I prefer a local joint When I use it I prefer a local joint block with 5-8 cc of a ½ Marcaine & block with 5-8 cc of a ½ Marcaine & Lidocaine either with or with out epi.Lidocaine either with or with out epi.

• IV meds include MS, Fentenyl, Valium, IV meds include MS, Fentenyl, Valium, Versed, Ketamine or Demerol.Versed, Ketamine or Demerol.

• Consider how long it takes to recover Consider how long it takes to recover and how long they may be in the and how long they may be in the ER/clinic.ER/clinic.

PRACTICE SESSIONPRACTICE SESSION

• Traction counter traction techniquesTraction counter traction techniques

• SAGER technique (why not to use)SAGER technique (why not to use)

• Scapular RotationsScapular Rotations

• Humeral lift techniquesHumeral lift techniques

• What to do if these do not work, what What to do if these do not work, what do you consider the reason & how do do you consider the reason & how do you correct it.you correct it.

Problems & RehabilitationProblems & Rehabilitation

• These take a while to heal & tighten These take a while to heal & tighten upup

• 4-6 weeks is average.4-6 weeks is average.

• Repeated subluxations frequently Repeated subluxations frequently need surgeryneed surgery

• Narcotics rarely needed unless a Narcotics rarely needed unless a complicated reduction or other issues complicated reduction or other issues of trauma needs to be consideredof trauma needs to be considered