injury of shoulder and upper arm no2

Inj. of shoulder and upper arm

Fracture clavical
In children easily
united rapidly
without any complication
In adult this can be much more troble some inj.

Mechanism of inj.

Fall on shoulder
Fall on out starched hand

Common site

midshaft
Outer segment displace downward
Inner segment displace upward

C.F
The arm clasped to chest
Immoblization
Subcutanous lump
Vas.inj. rare


Dx.
X_ray
AP veiw to shoulder
Direction

Rx
Sling
Until pain subsided(2-3)week

complication

Early
Pnemothorax
Damage subclavian vessels
Brachial plexus inj
All above rare

late

Malunion
Stiffness
Non union


Fracture scapula
Mechanism of inj.
Body direct or crushed inj.
Neck blow or fall on shoulder.
Corcoid process avulsion inj
Acromian direct force.
Glenoid occur with disl. Of shoulder.

C.f
Arm held immobile
Sever brusing overscapula and chest
Sever truma inj.tochest,spine,abd,head

X-ray

Plain x-ray
CT.scan

Rx
Neck usually impacted,sling(2-3)wks.
Glenoid depend on glenoid surface
a.less than 25% Conservative
b.more than 25% Surgical
Body surgery is not indicated
sling and early exercise
Acromian conservative and early exercise


Acromio-clavicular disl.
A cute inj. Is common and usually follows direct
Trauma.
Chronic sprain degenerative changes seen in athletic and working with jack – hammer and
Vibrating tool

Mech. Of inj.

Fall on the shoulder with the arm adducted may strain or tear the AC lig and upwards subluxation of the clavicle may occur .
If the force is severe the CC lig may be torn ; resulting complete disl. Of the joint

classification

Type 1 sprain
Type 2 subluxation
Type 3 disl.

X- Ray

Ap, lat.,axillary veiw.
Stress veiw 5 Kg. Defrantation between sub. And dislocation.



Rx
Sprain and sublaxation by sling (2 – 3 )weeks
Displacement padding and bandaging
if not control surgery

complication

Rotator cuff synd.
Unreduced dislocation .
Ossification of lig.
Secondary OA.

Dis. Sterno clavicular

Un common
Mech . Of inj. Lat. Compression of shoulder
Ant. Dis. More common than posterior.
Type of inj. Sprained , sublaxation and dis.

X- Ray

Ap.
Special oblique veiw
CT. scan


Rx
Sprian and subl. No need Rx.
Dislocation reduce

Dislocation of shoulder

Occur commonly due to
1.Shollowness of glenoid socket.
2.Extraordinary range of movement.

Type of dislocation

1.Anterior dislocation 95% most common
2.Postior dislocation
3.Inferior

Ant. dislocation

Common
Mech. Of inj. Fall on the hand.
Humers driven upward ,tearing of capsule or avalsion of glenoid labrum.



C.f
Sever pain
Support arm with other hand
Lateral boarder of shoulder Flat
In thin person prominance the head under clavical

X-ray

AP view
1.empty socket.
2.head medial to socket and below.
3.sss. Frature seen.

Rx
1.Stimson method
2.Hippocrate method
3.Kocher method

After reduction x-ray taken to confirm redution

And exclude fracture .
Neurological Ex.to exclud axillary N. inj.
Sling for 3wks under 30 years
1wk over 30 years
Elbow and Finger exersise started early.


Complication
Early
1.Rotator cuff synd.
2.N.inj Axillary,ulnar median.
3.Vascular inj.Axillary artery
4.Fracture ,disl.

Late

1.Stiffness of shoulder
2.Unreduce dislocation
3.Recurrent dislocation
4.instability

Posterior dislocation

Rare 2%
Mech. Of inj
Indirect force,internal rotation
and adduction
occur during fit and electrical shoch

Thank

You