Shoulder trauma

47 Shoulder trauma





Questions



image How do you manage a clavicle fracture?

image In what direction do most shoulders dislocate?

image How would you manage a displaced humeral shaft fracture?

Trauma around the shoulder is very common. The glenohumeral joint is a shallow ball and socket joint, where stability is sacrificed to allow a wide range of movement.


Many of the fractures and dislocations in this region are the result of falls, commonly a fall on an outstretched hand (‘FOOSH’).




Fractures of the clavicle


Fractures of the clavicle are common and often occur in a FOOSH (Fig. 3.47.1). Most occur in the middle third because ligaments firmly attach the medial and lateral ends. Neurovascular compromise of the distal limb is rare but may damage the subclavian artery and brachial plexus (check distal sensation and pulses).


image

Fig. 3.47.1 A fractured clavicle following a fall onto the shoulder.


Treatment is conservative with a broad arm sling for 3 weeks and analgesia. A ‘bump’ forms in the healed bone. Surgical reduction with ORIF is only needed if the fracture is open or there is neurovascular compromise, as it causes greater disability than conservative treatment.



Fractures of the humerus


Humeral fractures are common in those with osteoporosis, mainly occurring at the proximal humerus and the shaft of the humerus. Patients present with pain, tenderness, swelling and deformity, and an inability to move the shoulder.





Proximal humerus

Fractures of the neck of the humerus are usually caused by indirect trauma (e.g. a fall onto the shoulder in the elderly). Fractures through the surgical neck of the humerus are common, and since they are extracapsular, the blood supply is not disturbed and avascular necrosis is rare. Fractures through the anatomical neck are less common but have a high risk of avascular necrosis. Axillary nerve injury may occur with these fractures, hence deltoid sensation should be assessed. Most fractures are undisplaced and stable and are treated conservatively with a collar and cuff, which provides traction by gravity. Shoulder stiffness is a common complication, and so early physiotherapy in the elderly is important.

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Jul 3, 2016 | Posted by in MUSCULOSKELETAL MEDICINE | Comments Off on Shoulder trauma

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