Download
acute upper extremity injuries n.
Skip this Video
Loading SlideShow in 5 Seconds..
Acute Upper Extremity Injuries PowerPoint Presentation
Download Presentation
Acute Upper Extremity Injuries

Acute Upper Extremity Injuries

869 Views Download Presentation
Download Presentation

Acute Upper Extremity Injuries

- - - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

  1. Acute Upper Extremity Injuries CPT William Cooper D.O. Department of Orthopaedic Surgery DeWitt Army Community Hospital

  2. Topics Reviewed • Pectoralis Rupture • AC joint sprains • Shoulder dislocations • Clavicular fractures • Biceps Rupture • Radial head fractures • Elbow Dislocation • Skier’s thumb • Perilunate injuries • Scaphoid fractures • TFCC tears • Jersey Finger • Mallet Finger • Sagittal Band rupture

  3. Pectoralis Major Rupture • Excessive tension on maximally eccentrically contracted muscle • Weightlifters • Localized swelling and ecchymosis • Palpable defect • Weakness with adduction and internal rotation • Most common in men 20-50 • Complete rupture most common

  4. Pectoralis Major Rupture • Treatment • Surgical repair to bone for complete tears • Nonoperative for partial tears • Outcome • Less than ideal • Weakness, decreased ROM, increased muscle fatigue • Cosmesis

  5. AC joint sprains • AKA “separated shoulder” • Mechanism: • Blow to top of shoulder • May result from fall onto outstretched arm or elbow • Focal tenderness and pain with shoulder motion • Cross-chest adduction test usually positive

  6. Cross-Chest Adduction Test • AC joint • Adduct shoulder • Patient pushes elbow up against resistance • Pain in AC = + test • false + test in RC pathology

  7. Types of AC joint sprains

  8. AC joint sprains:Radiology eval • Standard AP shoulder views inadequate • usually over-penetrate the AC joint • Image both sides for comparison • Get specific AC joint view (Zanca) • AP with 10° cephalic incline • Axillary view can show posterior dislocation

  9. Normal AC joint

  10. Grade II AC joint sprain

  11. Grade III AC joint sprain

  12. Weighted AC x-rays seldom unmask unstable injures • Bossart PJ et al. Lack of efficacy of “weighted” radiographs in diagnosing acute acromioclavicular separations. Ann Emerg Med 1988; 117:20-24.

  13. Management of mild AC joint sprains (types I and II) • Ice, analgesia • Sling 1-3 weeks • Early ROM as pain permits • Strength exercises after full ROM achieved • Return to sports after pain-free function achieved

  14. Management of type IIIAC joint sprints • Initially same as for I and II • Referral to ortho advisable within 72 hours • Most authors advocate conservative management • Outcome just as good as surgery, with quicker recovery time

  15. Acute management of severe AC joint sprains (types IV, V, VI) • Ice, analgesia • Management of any complications (type VI associated with clavicle fxs, rib fxs, and brachial plexus injuries) • Sling/swath • Early referral

  16. Clavicular Fractures • One of the most common fractures • Classification • Middle third - most common (thinnest section) • Distal third • Proximal third • Image with AP thorax and 45° AP cephalic tilt • Rule out neurological or vascular compromise; pneumothorax in 3%

  17. Lateral third clavicle fracture

  18. ER Management ofClavicular Fractures • Ice, analgesics, arm support for all • Referral rule: • Any displaced, non-middle-thirdfractures • Shortening/displacement >2cm • Non-displaced fxs: sling; ROM prn comfort • Displaced middle-third fractures: figure 8 splint • Re-image in 7 days to assure reduction. If not, refer for shoulder spica cast

  19. Shoulder dislocations • Most commonly dislocated large joint • Anterior in 97% • Mechanism: force on abducted/externally rotated shoulder • Exam: • Shoulder externally rotated • Fullness anteriorly; acromion prominent post. • Neurovascular testing

  20. Radiology of shoulder dislocations • AP and axillary views; optional scapular lateral (Y) • Velpeau view • Look for fractures (not a contra-indication to reduction) • Always pre-reduction x-rays in primary cases • Optional pre-reduction x-rays in recurrent cases • Always post-reduction x-rays

  21. Anterior shoulder dislocation

  22. Anterior shoulder dislocation

  23. Posterior shoulder dislocation

  24. Hill-Sachs deformity

  25. Bankart lesion

  26. Shoulder dislocation reduction techniques • Types of maneuvers • Traction (Stimson, self-reduction, Hippocrates, Eskimo,Milch) • Scapular manipulation • Leverage (Kocher) • Combined maneuvers (slump, Snowbird)

  27. The Stimson technique for anterior shoulder dislocation reduction.

  28. J. Bone Joint Surg. Am., Dec 2009; 91: 2775 – 2782 • The FARES method • Significantly more effective, faster, and less painful method of reduction of an anterior shoulder dislocation in comparison with the Hippocratic and Kocher methods

  29. Post-reduction treatment for shoulder dislocation • Ice 72 hrs, NSAID 7-14 days • Immobilization 3-6 weeks • Capsule needs time to heal • Physical Therapy referral for rehab • Less immobilization (1 week) and quicker rehab in pts >40 (to prevent stiffness) and in recurrent dislocators

  30. Indications for early orthopedic referral for pts with shoulder dislocation • Displaced greater tuberosity fxs (>1 cm post-reduction) • Glenoid rim fxs displaced >5mm • Irreducible dislocations (soft tissue interposition) • Young athletes

  31. Biceps Tendon Rupture • Proximal rupture • Most common in age > 60 • Usually degenerative changes present initially • Usually hear/feel snap • Some may experience pain relief afterwards • Popeye deformity • Treatment nonoperative • Unless young patient with traumatic rupture

  32. Biceps Tendon Rupture • Distal Biceps Rupture • Much less common (5% of biceps ruptures) • Middle aged patients • Usually tendonopathy/degenerative changes present which predispose • Forceful, eccentric overload of the partially flexed elbow • Up to 50% loss of supination power has been documented after rupture • Treatment is surgical

  33. Biceps Tendon Rupture • The Hook Test for Distal Biceps Tendon Avulsion Am J Sports Med November 2007 35 1865-1869; published online before print August 8, 2007

  34. Does this happen in distal biceps rupture???

  35. Elbow trauma • Fractures • Dislocations • Ligament sprains • Look for compartment syndrome • Rule out neurovascular injury

  36. Axioms in elbow trauma radiograph evals • Look for fat pads signs (capsular effusion) • Anterior fat pad (from coronoid fossa) may be normal; compare to other side • Posterior fat pad (from olecranon fossa) is always abnormal • Compare to x-rays of other side in children • If elbow can’t be extended, obtain AP/lat of both humerus and forearm

  37. Fat pad signs

  38. Elbow fractures • Supracondylar, epicondylar • Radial head/neck • Olecranon • Coronoid process • **Consult current texts or your friendly local orthopedist for treatment of each.

  39. Radial head/neck fractures • Common fracture in adults • FOOSH usually • Detection may require oblique view • Assure proper alignment of head on capitellum (radiocapitellar line)

  40. Radial head fracture types • Type I: less than 2 mm displacement • Type II: angulated or >2 mm displaced • Type III: comminuted