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On the Field Management of Shoulder Injuries

On the Field Management of Shoulder Injuries. Jeff Allen Director of Sports Medicine University of Alabama. Shoulder Statistics. Football 13% of all reported time loss injuries 3 rd highest (knee, ankle) Avg. time loss of 7 days High School Survey

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On the Field Management of Shoulder Injuries

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  1. On the Field Management of Shoulder Injuries Jeff Allen Director of Sports Medicine University of Alabama

  2. Shoulder Statistics • Football • 13% of all reported time loss injuries • 3rd highest (knee, ankle) • Avg. time loss of 7 days • High School Survey • 10% of all time loss injuries (2005-2010) Datalys Center, NCAA Injury Surveillance Program

  3. Objectives in on the field management of injuries • Rule out/manage life or limb threatening injuries • Determine the extent of the injury • Determine Transportation Options/Method • Make a Return to Play Decision

  4. Is there a life-threatening injury??? • Airway • Breathing • Circulation • Disability • LOC • ALERT • VERBAL • PAIN • UNRESPONSIVE

  5. Is there a limb-threatening injury? • Vascular compromise • Open fracture • Overlying skin integrity • Neurological compromise

  6. Management of Life/Limb Threatening injuries • Short-term -Deal with ABCD’s • Medium-term -Manage injury/plan to transport • Long-term -Management plan -Notification

  7. Life/Limb threatening injuries to shoulder • Fractures • Clavicle • Scapula • Humerus • Dislocations • GH • SC • C-Spine????

  8. Fractures • Damage to the bone is the secondary concern • Primary concern is the damage the bone does to the surrounding structures • Evaluate Neurovascular Function Distally

  9. Clavicle fracture • Mechanism • Fall on Outstretched Hand • Signs and Symptoms • Sudden pain • Tenderness • Loss of shoulder function • Deformity(rapid swelling/bony deviation) • Head tilt towards side of fracture • Crepitus

  10. Scapula Fracture • Mechanism • Direct trauma • Indirect trauma from fall (on shoulder or arm) • Infrequent • Signs and Symptoms • Sudden pain • Painful abduction • Loss of function • Tenderness (direct/indirect) • Possible crepitus

  11. Humerus Fracture • Mechanism • Direct trauma • Fall on an outstretched arm • Signs and Symptoms • Sudden pain • Loss of function • Tenderness • Deformity • Rapid Swelling • Proximal or Shaft

  12. Dislocations of the shoulder • Mechanisms • Direct blow • Fall on Outstretched Arm • MDI • Signs and Symptoms • Deformity • Loss of motion • Neurovascular Status!!

  13. Posterior sc dislocation • Mechanism • Anterior dislocations of the SCJ are much more common (by a 9:1 ratio) • Direct blow • Fall on Outstretched Arm • Signs and Symptoms • Pain and Deformity • Altered Neurovascular Status • Complications may include: • Pneumothorax • Laceration of the superior vena cava • Occlusion of the subclavian artery or vein • Disruption of the trachea.

  14. Secondary issues with fractures/DISLOCATIONS • Pneumothorax • Hemothorax • Tracheobronchial injury • Neurovascular Injuries

  15. Neurovascular status!!! • PMSC • PULSE • MOTOR • SENSORY • CAPILLARY REFILL

  16. Non-Life Threatening injuries to the shoulder • YOU CAN RELAX NOW! • AC SPRAIN • SC SPRAIN • BPSI/NERVE INJURY • PEC RUPTURE

  17. TRANSPORTATION OPTIONS

  18. RETURN TO PLAY CRITERIA • ROM • STRENGTH • FUNCTIONAL ABILITY

  19. conclusion • Don’t complicate the obvious • “Boy Scout” Philosophy • Understand potential life/limb threatening injuries • Always remember to check neurovascular status!

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