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Shoulder Injuries Diagnosis & Treatment

Shoulder Injuries Diagnosis & Treatment. By Don Hudson, D.O., FACEP/ACOEP. Shoulder Injuries & what to consider. Rotator Cuff Injury Anterior Dislocation Posterior Dislocation Clavicle Fracture Humerus Fracture Vascular & Neurological Injuries Ligament injuries. Most Common .

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Shoulder Injuries Diagnosis & Treatment

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  1. Shoulder InjuriesDiagnosis & Treatment By Don Hudson, D.O., FACEP/ACOEP

  2. Shoulder Injuries & what to consider • Rotator Cuff Injury • Anterior Dislocation • Posterior Dislocation • Clavicle Fracture • Humerus Fracture • Vascular & Neurological Injuries • Ligament injuries

  3. Most Common • I will go over the most common injuries first. • The anterior shoulder dislocation • Clavicle fracture

  4. Anterior Dislocations • These usually occur because of a forceful downward motion against resistance with the humerus up & rotating • An example is a lay-up shot in basketball that is blocked by a downward motion from another player. • Of course any similar mechanism of injury will accomplish the same dislocation.

  5. Clavicle fractures • These occur because of axial loading along the long axis of the clavicle • Direct blow to the clavicle anterior to posterior • Depending on the patients age it will fracture (in younger patients) in medial 1/3 • In older patients it usually fractures in the lateral 1/3

  6. Posterior Dislocations • These usually occur because of a anterior to posterior motion, i.e. fall on an outstretched arm, motor vehicle accident, etc. • These frequently have neurological complications.

  7. Ligament Injuries • Ligament injuries are caused by normal motion taken beyond physiological limits • Acute injuries swell, bruise & hurt • Chronic injuries defined by crepitence & pain mainly because of scarring. • Early ROM helpful to prevent chronic state • ROM may decrease chronic pain

  8. Shoulder Anatomy

  9. More Shoulder Anatomy

  10. More Shoulder Anatomy

  11. Vascular Anatomy

  12. More Shoulder

  13. Potential Associated Injury

  14. Anterior Dislocations

  15. Posterior Dislocations

  16. Now what? • Your worries are? • Humerus Fracture • Brachial Plexus injury • Clavicle Fracture • Isolated vascular injury

  17. The thought is to do no harm • The reduction is done for pain relief. • Also for improvement of vascular or neurological compromise • The longer it is out of socket the longer rehabilitation will take • Lots of soft tissue ischemia is occuring

  18. Reductions • There are a lot of techniques available. • The two that are the least traumatic are the scapular rotation and “lifting of the arm. • The lifting procedure takes 2 fingers. • The scapula rotation is a little more complicated.

  19. Anesthesia • This can range for none to general depending on the patient. • Develop good rapport with them and explain the process and the amount of time when pain will be high. • Most choose no pain meds.

  20. Anesthesia • When I use it I prefer a local joint block with 5-8 cc of a ½ Marcaine & Lidocaine either with or with out epi. • IV meds include MS, Fentenyl, Valium, Versed, Ketamine or Demerol. • Consider how long it takes to recover and how long they may be in the ER/clinic.

  21. PRACTICE SESSION • Traction counter traction techniques • SAGER technique (why not to use) • Scapular Rotations • Humeral lift techniques • What to do if these do not work, what do you consider the reason & how do you correct it.

  22. Problems & Rehabilitation • These take a while to heal & tighten up • 4-6 weeks is average. • Repeated subluxations frequently need surgery • Narcotics rarely needed unless a complicated reduction or other issues of trauma needs to be considered

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