Inferior Dislocation of the Shoulder (Luxatio Erecta Humeri) Associated with Fracture and Transient Neurovascular Compromise
|
|
- Ralph Norman
- 7 years ago
- Views:
Transcription
1 J Med Sci ;():5- Copyright JMS Hsieh-Hsing Lee, et al. Inferior Dislocation of the Shoulder (Luxatio Erecta Humeri) Associated with Fracture and Transient Neurovascular Compromise Hsieh-Hsing Lee, Kuo-Hua Chao *, and Shing-Sheng Wu Department of Orthopedics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China Inferior dislocation of the shoulder, also known as luxatio erecta humeri, is extremely rare with an incidence reported to be.5% of all shoulder dislocations. The injury can occur in any age group and present in a unique and unusual fashion. The injury is most often unilateral. Several degrees of neurovascular injuries may be associated with the injury. Concomitant fracture of the coracoid, clavicle, acromion, greater tuberosity, and humeral head may also be noted. We report a case in which inferior dislocation of the shoulder occurred with an avulsion fracture of the greater tuberosity and transient neurovascular compromise. Key words: inferior shoulder dislocation, luxatio erecta, neurovascular compromise INTRODUCTION Luxatio erecta humeri occurs mainly as the result of severe abduction force of the arm. The neck of the humerus is levered against the acromion and the inferior capsule tears as the hemural head is forced out inferiorly. The other mechanism of injury is hyperabduction of the arm at the shoulder with extension at the elbow; the forearm is pronated. Direct or violent force is applied to the shoulder from a superior direction, causing inferior movement of the humeral head relative to the glenoid fossa. The inferior portion of the glenohumeral capsule is then disrupted, and inferior shoulder dislocation occurs. There are few reports regarding associated injuries accompanying inferior shoulder dislocation. We report a -year-old man who sustained inferior dislocation of the right shoulder with an avulsion fracture of the greater tuberosity and transient neurovascular compromise. CASE REPORT A -year-old man sustained a tumbling injury due to insertion of an umbrella into the anterior wheel when Received: August 11, 3; Revised: November 1, 3; Accepted: December 9, 3. * Corresponding author: Kuo-Hua Chao, Department of Orthopedics, Tri-Service General Hospital, 35, Cheng- Kung Road Section, Taipei 11, Taiwan, Republic of China. Tel: ; Fax: ; j3@ms3.hinet.net Fig. 1 The right humerus was hyperabducted, with flexion at the elbow and the forearm resting on the patient s head. riding a bicycle. When he attempted to stand up, he found that his right arm was painfully locked in an overhead position and he was unable to lower it. He was transported by ambulance to the emergency department of our hospital. Physical examination revealed that the right shoulder was in the hyperabduction position, with flexion at the elbow and with the forearm resting on the patient s head (Fig. 1). Severe pain rendered him unable to move his right shoulder. The head of the humerus was palpable against the lateral thoracic wall near the axilla. The radial pulse could not be detected at the right wrist. An area of hypesthesia with muscle weakness was noted over the right forearm and hand. The function of the axillary nerve could not be tested due to severe pain. 5
2 Inferior dislocation of the shoulder 3A 3B Fig. The radiograph before close reduction showed the humeral head below the glenoid fossa, while the shaft of the humerus pointed up and was in a rotated position. The fractured fragment could be noted on this film and marked by the white arrow. The radiographic film of the right shoulder showed the shaft of the humerus pointed up and was in a rotated position, with the dislocated humeral head below the glenoid fossa (Fig. ). Manipulative reduction by traction-counter-traction was performed immediately after the prescription of adequate analgesics. The forearm was straightened and in-line traction was applied to the fully abducted arm while firm cephalad pressure was maintained on the humeral head. Counter-traction was applied with a rolled bed sheet placed superior to the shoulder. When the humeral head was reduced into the glenoid fossa, an arc was swept in the coronal plane from the accentuated hyperabducted position medially and the arm was adducted toward the body and the forearm supinated. There was no audible clunk during reduction. The radiographic studies, which included anteroposterior and axillary views, were checked immediately after close reduction, and these films revealed anatomic reduction of the humeral head into the glenoid fossa (Fig. 3A,B). Hypesthesia of the forearm and hand disappeared after reduction. The pulse of radial artery was returned to normal. Tenderness of the greater tuberosity increased clinical awareness of associated injury, and an avulsion fracture of the greater tuberosity was evident in the post-reduction film, which revealed a displacement of greater than 5 mm. Fig. 3 (A) The radiograph of axillary view revealed anatomic reduction with the humeral head into the glenoid fossa. (B) The avulsion fracture of the greater tuberosity was noted on anteroposterior view after close reduction with the displacement greater than 5 mm. In consideration of which if left untreated, residual displacement greater than 5 mm could result in impingement against the acromion in elevation or abutment against the glenoid in external rotation 1. The patient s arm was temporarily placed in a sling and surgery was scheduled with open reduction and internal fixation of the avulsion fracture of the greater tuberosity. General anesthesia was used before the surgical procedure. With the patient lying in a beach-chair position, the arm was placed in the neutral position and the proce-
3 Hsieh-Hsing Lee, et al. Table 1 The Constant-Murley clinical method of functional assessment of the shoulder Reference weeks 1 weeks* PAIN (15) None Mild Moderate Severe 15 5 (15) ACTIVITIES TO DAILY LIVING () Activity Level Full work Full Recreation/Sport Unaffected Sleep () () () Positioning Up to Waist Up to Xiphoid Up to Neck Up to Top of Head Above Head () () RANGE OF MOTION () Forward Elevation () -3 o 31- o 1-9 o 91- o o o () () Lateral Elevation () -3 o 31- o 1-9 o 91- o o o () () External Rotation () Hand behind Head-Elbow Forward Hand behind Head-Elbow Back Hand on Top of Head-Elbow Forward Hand on Top of Head-Elbow Back Full Elevation from Top of Head () () () () () Internal Rotation () Dorsum of Hand to Lateral Thigh Dorsum of Hand to Buttock Dorsum of Hand to Lumbosacral Junction Dorsum of Hand to Waist (3rd Lumbar Vertebra) Dorsum of Hand to 1th Dorsal Vertebra Dorsum of Hand to Intercapsular Region (7th Dorsal Vertebra) () () POWER (5) (With a spring balance or a Cybex ) 5 (15) () TOTAL 5 9 * We used the rating system to evaluate the patient s shoulder at and 1 weeks after the operation,3. dure was performed using a deltopectoral approach. The fragment of the greater tuberosity was found to be a large one that could support plate and screw fixation, and a cloverleaf plate with screws was applied. Immobilization with a sling was applied postoperatively to allow the soft tissue of the inferior capsule to heal. His sling was removed weeks after the surgical procedure, and a program of rehabilitation began thereafter. We used the Constant-Murley rating system to evaluate the functional improvement of the affected shoulder weeks postoperatively, in the outpatient department. The patient score was 5 points,3. The same evaluation was done again at the 1th week postoperatively, with the score improving to 9 (Table 1). 7
4 Inferior dislocation of the shoulder At months postoperatively, the patient returned to the outpatient department of our hospital for another followup. He did not complain of pain and his upper extremity remained neurologically intact. He had regained a nearly full active range of motion in the shoulder and had no apprehension or instability toward elevation or rotation. There was full recovery of motor power. Radiographic study showed retention of implants and bony union of the greater tuberosity. He could return to preinjury activities, and he was back at work as a laborer. DISCUSSION Luxatio erecta, or inferior shoulder dislocation, is an extremely uncommon variety of the very common problem of shoulder dislocations, and was first described in 159 by Middledorpf and Scharm. This rare shoulder dislocation accounts for less than 1% of all shoulder dislocations. This injury can occur at any age 5. The classical presentation is with the arm fully abducted, elbow flexed, and the forearm resting on or behind the patient s head. Creases may be present over the superior aspect of the shoulder and the glenoid fossa will be empty with the humeral head palpable on the lateral chest wall. The patient will generally resist any attempt at movement of the affected arm. Neurovascular compromise involving the axillary artery and the brachial plexus may be present 7. The mechanism of injury involves hyperabduction of the humerus. As the humerus is abducted, it impinges upon the acromion, causing a tear in the inferior glenohumeral capsule and disruption of the rotator cuff. Fractures of the acromion, inferior glenoid, and greater tuberosity of the humerus can occur 9. The force of the injury can be great enough to cause an open fracture-dislocation. The clinical presentation of luxatio erecta humeri is dramatic. The initial impression may suggest hysteria. The arm, which is locked in severe abduction, points straight upward alongside the head with the elbow flexed. The forearm frequently rests behind the head or across the top of the head. The glenoid fossa is empty and the humeral head is palpated in the axilla adjacent to the lateral chest wall. Skin creases are noted on the superior aspect of the shoulder, indicating the acute angle formed by the acromion and humerus. It is impossible to lower the arm from this position without causing excruciating pain. On radiographs, the head of the humerus is seen below the glenoid, while the shaft of the humerus points up and is in a rotated position. Therefore, the radiological evaluation of the shoulder should include the injured part, in two views at right angles to each other 7. A lateral film, in addition to the anteroposterior views, must be obtained to complete the shoulder series. Anteroposterior views are taken of internal and external rotation of the humerus (routine anteroposterior) with the tube angled 5 o laterally from the midline (true anteroposterior). Lateral views are taken in the plane of the scapula (Y view) or in the plane of axilla (axillary) 7. Both views allow the relationship of the humeral head to the glenoid and be evaluated further, and show possible fractures of the glenoid, coracoid process, and humeral head. The Y view has the benefit of being taken without moving the upper extremity. Careful attention must be directed toward making the distinction between anterior and inferior shoulder dislocations. A recent report describing luxatio erecta suggests it was initially misdiagnosed as an anterior dislocation 11, and standard approaches to reduction of anterior dislocation were unsuccessful. Complications may be found: 1) Recurrence: Recurrent inferior dislocation of the shoulder is very unusual. ) Softtissue injuries: Disruptions of various shoulder muscles (supraspinatus, infraspinatus, subscapularis, and pectoralis major). 3) Fractures: Fractures of the clavicle, coracoid, acromion, inferior glenoid, and greater tuberosity of the humerus. Concomitant fracture or rotator cuff injury is reported in % of cases. Fracture of the greater tuberosity of the humerus reportedly spares injury to the rotator cuff. ) Neurologic injury: % of cases manifest neurologic injury on presentation, most commonly to the axillary nerve. The neurologic deficits usually resolve in rapid fashion. 5) Vascular injury: A small percentage of cases are complicated by vascular injury, which is usually associated with a decreased radial pulse. Our case presented with the last three clinical symptoms. The greater tuberosity was avulsed by the rotator cuff when the humeral head dislocated inferiorly. All the three cords of the brachial plexus pass through the axilla and would be tethered in the dislocated position, and accordingly, our case presented the symptoms of hypesthesia and muscle weakness over the right forearm and hand before closed reduction. The axillary vessels might be compressed in the dislocated position and therefore the radial pulse could not be palpated in our case. Notwithstanding the severity of neurovascular symptoms, disability in our case was transient and significant improvement was noted after reduction of his shoulder joint. Most cases of luxatio erecta can be managed by closed reduction in the emergency department, unless a buttonhole incarceration of the inferior capsule exists; then open reduction may be necessary. Adequate muscle relaxation and anesthesia are essential for reduction. One method of
5 Hsieh-Hsing Lee, et al. reduction involves in-line traction of the fully abducted arm superiorly as upward pressure is applied to the humeral head. Simultaneous counter-traction is applied inferiorly with a folded sheet placed over the top of the shoulder. When the humeral head is reduced into the glenoid fossa, the arm is adducted in an arc toward the body 1. The shoulder is then immobilized with a shoulder immobilizer or a sling and swathe. Postreduction anteroposterior and lateral radiographs are examined for adequate reduction and associated fractures. Accurate diagnosis of inferior shoulder dislocation, with attention to neurovascular compromise, will prevent iatrogenic injuries and complications during close reduction. If the technique of close reduction is correctly applied and the associated fractures are adequately treated, the functional recovery of the shoulder joint is nearly complete and the clinical result will be excellent. REFERENCES 1. Dirschl DR. Shoulder trauma: bone. In: Koval KJ, ed. Orthopaedic Knowledge Update 7: Home Study Syllabus. Rosemont: American Academy of Orthopaedic Surgeons, :3-.. Welsh P. Standardized assessment of shoulder function. Presented at the meeting of the American Shoulder and Elbow Surgeons, Los Angeles, Oct, 195 (including the Constant-Murley assessment method). 3. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat R 197;1:1-1.. Middledorpf M, Scharm B. De nova humeri luxationis specie. Clinique Europenne 159;: Laskin RS. Luxatio erecta in infancy. Clin Orthop 1971;71: Zimmers T. Luxatio erecta: an uncommon shoulder dislocation. Ann Emerg Med 193;1: Wirth MA, Rockwood CA. Subluxations and dislocations about the glenohumeral joint. In: Bucholz RW, Heckman JD, eds. Fractures in Adults. 5th ed. Philadelphia, PA: Williams & Wilkins, 1: Simon RR, Koenigshnecht SJ. Emergency Orthopedics. nd ed. Norwalk, CT: Appleton & Lange, 197: Kothari K, Bernstein RM, Griffiths HJ, Standertskjold- Nordenstam CG, Choi PK. Luxatio erecta. Skeletal Radiol 19;11:7-9.. Harris HJ, Harris WH. Radiology of Emergency Medicine. 1st ed. Baltimore, MD: Williams & Wilkins, 1975: Pirrallo RG, Bridges TP. Luxatio erecta: a missed diagnosis. Am J Emerg Med 199;: Freundlich BD. Luxatio erecta. J Trauma 193;5:3-3. 9
6 Inferior dislocation of the shoulder
Chapter 5. The Shoulder Joint. The Shoulder Joint. Bones. Bones. Bones
Copyright The McGraw-Hill Companies, Inc. Reprinted by permission. Chapter 5 The Shoulder Joint Structural Kinesiology R.T. Floyd, Ed.D, ATC, CSCS Structural Kinesiology The Shoulder Joint 5-1 The Shoulder
More informationSCAPULAR FRACTURES. Jai Relwani, Shoulder Fellow, Reading Shoulder Unit, Reading.
SCAPULAR FRACTURES Jai Relwani, Shoulder Fellow, Reading Shoulder Unit, Reading. Aims Anatomy Incidence/Importance Mechanism Classification Principles of treatment Specific variations Conclusion Anatomy
More informationRotator Cuff Pathophysiology. treatment program that will effectively treat it. The tricky part about the shoulder is that it is a ball and
Rotator Cuff Pathophysiology Shoulder injuries occur to most people at least once in their life. This highly mobile and versatile joint is one of the most common reasons people visit their health care
More informationShoulder Injuries. Why Bother? QAS Injury Prevalence. Screening Injury 29.2% 12 month cumulative injury prevalence. Dr Simon Locke
Shoulder Injuries Dr Simon Locke Why Bother? Are shoulder and upper limb injuries common? Some anatomy What, where, what sports? How do they happen? Treatment, advances? QAS Injury Prevalence Screening
More informationRotator Cuff Tears in Football
Disclosures Rotator Cuff Tears in Football Roger Ostrander, MD Consultant: Mitek Consultant: On-Q Research Support: Arthrex Research Support: Breg Research Support: Arthrosurface 2 Anatomy 4 major muscles:
More informationTHE SHOULDER JOINT T H E G L E N O H U M E R A L ( G H ) J O I N T
THE SHOULDER JOINT T H E G L E N O H U M E R A L ( G H ) J O I N T CLARIFICATION OF TERMS Shoulder girdle = scapula and clavicle Shoulder joint (glenohumeral joint) = scapula and humerus Lippert, p115
More informationDiagnosis of Acromioclavicular Joint Injuries
PO Box 15 Rocky Hill, CT 06067 (860) 463-9003 Chiroeducation@aol.com www.chirocredit.com ChiroCredit.com is proud to present a section from one of our continuing education programs: Physical Diagnosis
More informationShoulder Examination
Shoulder Examination Summary Inspection Palpation Movement Special Tests Neurological examination Introduction Shoulder disorders are can be broadly classified into the following types: Pain Stiffness
More informationRehabilitation Guidelines for Posterior Shoulder Reconstruction with or without Labral Repair
Rehabilitation Guidelines for Posterior Shoulder Reconstruction with or without Labral Repair The anatomic configuration of the shoulder joint (glenohumeral joint) is often compared to a golf ball on a
More informationRehabilitation Guidelines for Arthroscopic Capsular Shift
Rehabilitation Guidelines for Arthroscopic Capsular Shift The anatomic configuration of the shoulder joint (glenohumeral joint) is often compared to a golf ball on a tee. This is because the articular
More informationAnterior Capsular Repair Rehabilitation Program Methodist Sports Medicine Center, Indianapolis, IN Department of Physical Therapy
Anterior Capsular Repair Rehabilitation Program Methodist Sports Medicine Center, Indianapolis, IN Department of Physical Therapy Anterior Capsule reconstruction is a surgical procedure utilized for anterior
More informationHand and Upper Extremity Injuries in Outdoor Activities. John A. Schneider, M.D.
Hand and Upper Extremity Injuries in Outdoor Activities John A. Schneider, M.D. Biographical Sketch Dr. Schneider is an orthopedic surgeon that specializes in the treatment of hand and upper extremity
More informationBODY BODY PEDICLE PEDICLE TRANSVERSE TRANSVERSE PROCESS PROCESS
Learning Objective Radiology Anatomy of the Spine and Upper Extremity Identify anatomic structures of the spine and upper extremities on standard radiographic and cross-sectional images Timothy J. Mosher,
More informationUpper Limb QUESTIONS UPPER LIMB: QUESTIONS
1 Upper Limb QUESTIONS 1.1 Which of the following statements best describes the scapula? a. It usually overlies the 2nd to 9th ribs. b. The spine continues laterally as the coracoid process. c. The suprascapular
More informationShoulder Pain and Weakness
Shoulder Pain and Weakness John D. Kelly IV, MD THE PHYSICIAN AND SPORTSMEDICINE - VOL 32 - NO. 11 - NOVEMBER 2004 For CME accreditation information, instructions and learning objectives, click here. A
More informationCommon Pediatric Fractures. Quoc-Phong Tran, MD UNSOM Primary Care Sports Medicine Fellow November 6, 2014
Common Pediatric Fractures Quoc-Phong Tran, MD UNSOM Primary Care Sports Medicine Fellow November 6, 2014 Pediatric fractures 20% of injured kids found to have fracture on evaluation Between birth and
More informationMs. Ruth Delaney ROTATOR CUFF DISEASE Orthopaedic Surgeon, Shoulder Specialist
WHAT DOES THE ROTATOR CUFF DO? WHAT DOES THE ROTATOR CUFF DO? WHO GETS ROTATOR CUFF TEARS? HOW DO I CLINICALLY DIAGNOSE A CUFF TEAR? WHO NEEDS AN MRI? DOES EVERY CUFF TEAR NEED TO BE FIXED? WHAT DOES ROTATOR
More informationA Patient s Guide to Shoulder Pain
A Patient s Guide to Shoulder Pain Part 2 Evaluating the Patient James T. Mazzara, M.D. Shoulder and Elbow Surgery Sports Medicine Occupational Orthopedics Patient Education Disclaimer This presentation
More informationAdult Forearm Fractures
Adult Forearm Fractures Your forearm is made up of two bones, the radius and ulna. In most cases of adult forearm fractures, both bones are broken. Fractures of the forearm can occur near the wrist at
More informationImportant rehabilitation management concepts to consider for a postoperative physical therapy rtsa program are:
: General Information: Reverse or Inverse Total Shoulder Arthroplasty (rtsa) is designed specifically for the treatment of glenohumeral (GH) arthritis when it is associated with irreparable rotator cuff
More informationJ F de Beer, K van Rooyen, D Bhatia. Rotator Cuff Tears
1 J F de Beer, K van Rooyen, D Bhatia Rotator Cuff Tears Anatomy The shoulder consists of a ball (humeral head) and a socket (glenoid). The muscles around the shoulder act to elevate the arm. The large
More informationClarification of Terms
Shoulder Girdle Clarification of Terms Shoulder girdle = scapula and clavicle Shoulder joint (glenohumeral joint) = scapula and humerus What is the purpose (or function) of the shoulder and entire upper
More informationReview Article. Dislocation Of Shoulder Joint
Review Article Dislocation Of Shoulder Joint Hafizuddin Ahmed A. H. Introduction: Dislocation means complete loss of contact of the articular surfaces of bony components of a joint. Shoulder joint is the
More informationShoulder Instability. Fig 1: Intact labrum and biceps tendon
Shoulder Instability What is it? The shoulder joint is a ball and socket joint, with the humeral head (upper arm bone) as the ball and the glenoid as the socket. The glenoid (socket) is a shallow bone
More informationShoulder MRI for Rotator Cuff Tears. Conor Kleweno,, Harvard Medical School Year III Gillian Lieberman, MD
Shoulder MRI for Rotator Cuff Tears Conor Kleweno,, Harvard Medical School Year III Goals of Presentation Shoulder anatomy Function of rotator cuff MRI approach to diagnose cuff tear Anatomy on MRI images
More information.org. Fractures of the Thoracic and Lumbar Spine. Cause. Description
Fractures of the Thoracic and Lumbar Spine Page ( 1 ) Spinal fractures can vary widely in severity. While some fractures are very serious injuries that require emergency treatment, other fractures can
More informationINJURIES OF THE HAND AND WRIST By Derya Dincer, M.D.
05/05/2007 INJURIES OF THE HAND AND WRIST By Derya Dincer, M.D. Hand injuries, especially the fractures of metacarpals and phalanges, are the most common fractures in the skeletal system. Hand injuries
More informationTHE REVERSE SHOULDER REPLACEMENT
THE REVERSE SHOULDER REPLACEMENT The Reverse Shoulder Replacement is a newly approved implant that has been used successfully for over ten years in Europe. It was approved by the FDA for use in the U.S.A.
More informationRehabilitation Guidelines for Anterior Shoulder Reconstruction with Arthroscopic Bankart Repair
Rehabilitation Guidelines for Anterior Shoulder Reconstruction with Arthroscopic Bankart Repair The anatomic configuration of the shoulder joint (glenohumeral joint) is often compared to a golf ball on
More informationShoulder Arthroscopy
Copyright 2011 American Academy of Orthopaedic Surgeons Shoulder Arthroscopy Arthroscopy is a procedure that orthopaedic surgeons use to inspect, diagnose, and repair problems inside a joint. The word
More informationArthroscopic Shoulder Procedures. David C. Neuschwander MD. Shoulder Instability. Allegheny Health Network Orthopedic Associates of Pittsburgh
Arthroscopic Shoulder Procedures David C. Neuschwander MD Allegheny Health Network Orthopedic Associates of Pittsburgh Shoulder Instability Anterior Instability Posterior Instability Glenohumeral Joint
More informationProximal Humeral Fracture Repair and Rehabilitation
1 Proximal Humeral Fracture Repair and Rehabilitation Surgical Indications and Considerations Anatomical Considerations: Numerous types of proximal humeral fractures can occur each of which have separate
More informationUpper limb injuries. Traumatology RHS 231 Dr. Einas Al-Eisa
Upper limb injuries Traumatology RHS 231 Dr. Einas Al-Eisa Pain in the limbs: May be classified under 4 headings: 1. Joint pain 2. Soft tissue pain 3. Neurogenic pain 4. Orthopaedic causes (fractures,
More informationSplit Pectoralis Major and Teres Major Tendon Transfers for Reconstruction of Irreparable Tears of the Subscapularis
Techniques in Shoulder & Elbow Surgery 5(1):5 12, 2004 2004 Lippincott Williams & Wilkins, Philadelphia T E C H N I Q U E Split Pectoralis Major and Teres Major Tendon Transfers for Reconstruction of Irreparable
More informationOrthopaedic and Spine Institute 21 Spurs Lane, Suite 245, San Antonio, TX 78240 www.saspine.com Tel# 210-487-7463
Phase I Passive Range of Motion Phase (postop week 1-2) Minimize shoulder pain and inflammatory response Achieve gradual restoration of gentle active range of motion Enhance/ensure adequate scapular function
More informationMuscle Energy Technique. Applied to the Shoulder
Muscle Energy Technique Applied to the Shoulder MUSCLE ENERGY Theory Muscle energy technique is a manual therapy procedure which involves the voluntary contraction of a muscle in a precisely controlled
More informationInjuries to Upper Limb
Injuries to Upper Limb 1 The following is a list of common sporting conditions and injuries. The severity of each condition may lead to different treatment protocols and certainly varying levels of intervention.
More informationRehabilitation Guidelines For SLAP Lesion Repair
Rehabilitation Guidelines For SLAP Lesion Repair The anatomic configuration of the shoulder joint (glenohumeral joint) is often compared to a golf ball on a tee. This is because the articular surface of
More informationCombined lesions of the glenoid labrum include labral
9(1):10 14, 2008 Ó 2008 Lippincott Williams & Wilkins, Philadelphia T E C H N I Q U E Arthroscopic Repair of Combined Labral Lesions MAJ Brett D. Owens, MD, Bradley J. Nelson, MD, and COL Thomas M. DeBerardino,
More information.org. Shoulder Pain and Common Shoulder Problems. Anatomy. Cause
Shoulder Pain and Common Shoulder Problems Page ( 1 ) What most people call the shoulder is really several joints that combine with tendons and muscles to allow a wide range of motion in the arm from scratching
More informationCompleting the Loop: Management of the Adolescent Sports Injury. Adam Thomas, PT, DPT, ATC
: Management of the Adolescent Sports Injury Adam Thomas, PT, DPT, ATC https://www.youtube.com/watch?v=vbufpo 8s3As On field assessment can be the most efficient when the health care provider has observed
More informationElbow Examination. Haroon Majeed
Elbow Examination Haroon Majeed Key Points Inspection Palpation Movements Neurological Examination Special tests Joints above and below Before Starting Introduce yourself Explain to the patient what the
More informationBiceps Tenodesis Protocol
Department of Rehabilitation Services Physical Therapy The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone
More informationUpper Extremity Special Tests. Cervical Tests. TMJ Dysfunction
Upper Extremity Special Tests Cervical Tests Vertebral Artery Test: used to test for vertebral artery occlusion or insufficiency. The subject lies supine on the plinth with the examiner seated behind with
More informationChapter 4 The Shoulder Girdle
Chapter 4 The Shoulder Girdle Key Manubrium Clavicle Coracoidprocess Acromionprocess bony landmarks Glenoid fossa Bones Lateral Inferior Medial border angle McGraw-Hill Higher Education. All rights reserved.
More information.org. Rotator Cuff Tears. Anatomy. Description
Rotator Cuff Tears Page ( 1 ) A rotator cuff tear is a common cause of pain and disability among adults. In 2008, close to 2 million people in the United States went to their doctors because of a rotator
More informationRehabilitation after shoulder dislocation
Physiotherapy Department Rehabilitation after shoulder dislocation Information for patients This information leaflet gives you advice on rehabilitation after your shoulder dislocation. It is not a substitute
More informationTHE SHOULDER. Shoulder Pain. Fractures. Instability and Dislocations of the Shoulder
THE SHOULDER Shoulder Pain 1. Fractures 2. Sports injuries 3. Instability/Dislocations 4. Rotator Cuff Disease and Tears 5. Arthritis Fractures The shoulder is made up of three primary bones, the clavicle,
More informationShoulder and Related Upper Extremity Radiating Pain
Shoulder and Related Upper Extremity Radiating Pain ICD-9-CM codes: 723.3 Cervical brachial syndrome ICF codes: Activities and Participation Domain codes: d4301 Carrying in the hands (Taking or transporting
More informationTOWN CENTER ORTHOPAEDIC ASSOCIATES P.C. Labral Tears
Labral Tears The shoulder is your body s most flexible joint. It is designed to let the arm move in almost any direction. But this flexibility has a price, making the joint prone to injury. The shoulder
More informationCAPPAGH NATIONAL ORTHOPAEDIC HOSPITAL, FINGLAS, DUBLIN 11. The Sisters of Mercy. Rotator Cuff Repair
1.0 Policy Statement... 2 2.0 Purpose... 2 3.0 Scope... 2 4.0 Health & Safety... 2 5.0 Responsibilities... 2 6.0 Definitions and Abbreviations... 3 7.0 Guideline... 3 7.1 Pre-Operative... 3 7.2 Post-Operative...
More informationX-Ray Rounds: (Plain) Radiographic Evaluation of the Shoulder
X-Ray Rounds: (Plain) Radiographic Evaluation of the Shoulder Anatomy 3 Bones Humerus Scapula Clavicle 3 Joints Glenohumeral Acromioclavicular Sternoclavicular 1 Articulation Scapulothoracic Anatomy Humerus
More informationArthroscopic Labral Repair (SLAP)
Arthroscopic Labral Repair (SLAP) Brett Sanders, MD Center For Sports Medicine and Orthopaedic 2415 McCallie Ave. Chattanooga, TN (423) 624-2696 Anatomy The shoulder joint involves three bones: the scapula
More information.org. Rotator Cuff Tears: Surgical Treatment Options. When Rotator Cuff Surgery is Recommended. Surgical Repair Options
Rotator Cuff Tears: Surgical Treatment Options Page ( 1 ) The following article provides in-depth information about surgical treatment for rotator cuff injuries, and is a continuation of the article Rotator
More informationCase 2. 30 year old involved in a MVA complaining of chest pain. Bruising over the right upper chest. Your Diagnosis
Case 2 30 year old involved in a MVA complaining of chest pain. Bruising over the right upper chest. Your Diagnosis Diagnosis: Posterior Sterno-clavicular dislocation [PSCD] A posterior sterno-clavicular
More informationRotator Cuff Repair and Rehabilitation
1 Rotator Cuff Repair and Rehabilitation Surgical Indications and Considerations Anatomical Considerations: The rotator cuff complex is comprised of four tendons from four muscles: supraspinatus, infraspinatus,
More informationThis article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and
This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution
More information1 of 6 1/22/2015 10:06 AM
1 of 6 1/22/2015 10:06 AM 2 of 6 1/22/2015 10:06 AM This cross-section view of the shoulder socket shows a typical SLAP tear. Injuries to the superior labrum can be caused by acute trauma or by repetitive
More information28% have partial tear of the rotator cuff.
ROTATOR CUFF TENDON RUPTURE Anatomy: 1. Rotator cuff consists of: Subscapularis anteriorly, Supraspinatus superiorly and Infraspinatus and Teres minor posteriorly. 2 Biceps tendon is present in the rotator
More informationMusculoskeletal Ultrasound Technical Guidelines. I. Shoulder
European Society of MusculoSkeletal Radiology Musculoskeletal Ultrasound Technical Guidelines I. Shoulder Ian Beggs, UK Stefano Bianchi, Switzerland Angel Bueno, Spain Michel Cohen, France Michel Court-Payen,
More informationImaging of Lisfranc Injury
November 2011 Imaging of Lisfranc Injury Greg Cvetanovich, Harvard Medical School Year IV Agenda Case Presentation Introduction Anatomy Lisfranc Injury Classification Imaging Treatment 2 Case Presentation
More informationRehabilitation Guidelines for Shoulder Arthroscopy
Rehabilitation Guidelines for Shoulder Arthroscopy Front View Long head of bicep Acromion Figure 1 Shoulder anatomy Supraspinatus Image Copyright 2010 UW Health Sports Medicine Center. Short head of bicep
More informationSHOULDER INSTABILITY. E. Edward Khalfayan, MD
SHOULDER INSTABILITY E. Edward Khalfayan, MD Instability of the shoulder can occur from a single injury or as the result of repetitive activity such as overhead sports. Dislocations of the shoulder are
More informationShoulder Impingement/Rotator Cuff Tendinitis
Copyright 2011 American Academy of Orthopaedic Surgeons Shoulder Impingement/Rotator Cuff Tendinitis One of the most common physical complaints is shoulder pain. Your shoulder is made up of several joints
More informationASOP Exams PO Box 7440 Seminole, FL 33775. The Manual of Fracture Casting & Bracing Exam 80% Passing ID # Name Title. Address. City State Zip.
The Manual of Fracture Casting & Bracing Exam 80% Passing ID # Name Title Address City State Zip Tel# Email Certification Organization Cert# Mail a copy of your completed exam to: ASOP Exams PO Box 7440
More informationMusculoskeletal: Acute Lower Back Pain
Musculoskeletal: Acute Lower Back Pain Acute Lower Back Pain Back Pain only Sciatica / Radiculopathy Possible Cord or Cauda Equina Compression Possible Spinal Canal Stenosis Red Flags Initial conservative
More informationThe Shoulder Complex & Shoulder Girdle
The Shoulder Complex & Shoulder Girdle The shoulder complex 4 articulations involving The sternum The clavicle The ribs The scapula and The humerus Bony Landmarks provide attachment points for muscles
More informationwww.ghadialisurgery.com
P R E S E N T S Dr. Mufa T. Ghadiali is skilled in all aspects of General Surgery. His General Surgery Services include: General Surgery Advanced Laparoscopic Surgery Surgical Oncology Gastrointestinal
More information31 Clavicle Fractures George M. Bridgeforth, Shane J. Nho, Rachel M. Frank, and Brian J. Cole
LWBK652-c31_p152-156.qxd 5/17/10 11:32 PM Page 152 Aptara Inc CHAPTER 31 Clavicle Fractures George M. Bridgeforth, Shane J. Nho, Rachel M. Frank, and Brian J. Cole CLINICAL POINTS Most clavicle fractures
More informationWrist Fracture. Please stick addressograph here
ORTHOPAEDIC UNIT: 01-293 8687 /01-293 6602 UPMC BEACON CENTRE FOR ORTHOPAEDICS: 01-2937575 PHYSIOTHERAPY DEPARTMENT: 01-2936692 GUIDELINES FOR PATIENTS FOLLOWING WRIST FRACTURE Please stick addressograph
More informationGlenohumeral stability is provided by the integrity
Technical Note Arthroscopic Thermal Capsulorrhaphy as Treatment for the Unstable Paralytic Shoulder Eric J. Strauss, M.D., Stephen Fealy, M.D., Michael Khazzam, M.D., Joshua S. Dines, M.D., and Edward
More informationTotal Elbow Arthroplasty and Rehabilitation
Total Elbow Arthroplasty and Rehabilitation Surgical Indications and Considerations Anatomical Considerations: There are three bones and four joint articulations that have a high degree of congruence in
More informationRotator cuff tears Acute or chronic? Mary Obele ANZSOM September 2012 Acknowledgement: ACC
Rotator cuff tears Acute or chronic? Mary Obele ANZSOM September 2012 Acknowledgement: ACC Anatomy Epidemiology Asymptomatic rotator cuff tears: prevalence is 35% (5) 15% full thickness and 20% partial
More informationShoulder Impingement Syndrome
Shoulder Impingement Syndrome Causes The shoulder joint is stabilized and moved mainly by the four tendons of the socalled rotator cuff. These tendons are situated in a narrow bony canal between the ball
More informationSymptoms and Signs of Irritation of the Brachial Plexus in Whiplash Injuries
1 Symptoms and Signs of Irritation of the Brachial Plexus in Whiplash Injuries J Bone Joint Surg (Br) 2001 Mar;83(2):226-9 Ide M, Ide J, Yamaga M, Takagi K Department of Orthopaedic Surgery, Kumamoto University
More informationManagement of common upper limb fractures in Adults and Children. Dr Matthew Sherlock Shoulder and Elbow Orthopaedic Surgeon
Management of common upper limb fractures in Adults and Children Dr Matthew Sherlock Shoulder and Elbow Orthopaedic Surgeon Outline Immobilisation choices Adults Clavicle Fractures Proximal Humeral Fractures
More informationRADIOGRAPHIC EVALUATION
Jeff Husband MD Objectives Evaluate, diagnose and manage common wrist injuries due to high energy trauma in athletes Appropriately use radiographs, CT scans and MRI Know when to refer patients for additional
More informationDr. Benjamin Hewitt. Shoulder Stabilisation
Please contactmethroughthegoldcoasthospitaswityouhaveanyproblemsafteryoursurgery. Dr. Benjamin Hewitt Orthopaedic Surgeon Shoulder Stabilisation The shoulder is the most flexible joint in the body, allowing
More informationSLAP Repair Protocol
SLAP Repair Protocol Anatomy and Biomechanics The shoulder is a wonderfully complex joint that is made up of the ball and socket connection between the humerus (ball) and the glenoid portion of the scapula
More informationA Simplified Approach to Common Shoulder Problems
A Simplified Approach to Common Shoulder Problems Objectives: Understand the basic categories of common shoulder problems. Understand the common patient symptoms. Understand the basic exam findings. Understand
More informationRotator Cuff Repair Protocol
Rotator Cuff Repair Protocol Anatomy and Biomechanics The shoulder is a wonderfully complex joint that is made up of the ball and socket connection between the humerus (ball) and the glenoid portion of
More informationHow To Fix A Radial Head Plate
Mayo Clinic CoNGRUENT RADIAL HEAD PLATE Since 1988 Acumed has been designing solutions to the demanding situations facing orthopedic surgeons, hospitals and their patients. Our strategy has been to know
More informationObjectives. Spinal Fractures: Classification Diagnosis and Treatment. Level of Fracture. Neuro exam Muscle Grading
Objectives Spinal Fractures: Classification Diagnosis and Treatment Johannes Bernbeck,, MD Review and apply the understanding of incidence and etiology of VCF. Examine conservative and operative management
More informationBiceps Brachii Tendon Proximal Rupture
1 Biceps Brachii Tendon Proximal Rupture Surgical Indications and Considerations Anatomical Considerations: Biceps brachii, one of the dominant muscles of the arm, is involved in functional activities
More information.org. Clavicle Fracture (Broken Collarbone) Anatomy. Description. Cause. Symptoms
Clavicle Fracture (Broken Collarbone) Page ( 1 ) A broken collarbone is also known as a clavicle fracture. This is a very common fracture that occurs in people of all ages. Anatomy The collarbone (clavicle)
More informationREHAB 544 FUNCTIONAL ANATOMY OF THE UPPER EXTREMITY & LOWER EXTREMITY
REHAB 544 FUNCTIONAL ANATOMY OF THE UPPER EXTREMITY & LOWER EXTREMITY Mark Guthrie, PhD Rehabilitation Medicine University of Washington REHAB 544: Musculoskeletal Anatomy of the Upper & Lower Extremities,
More informationRotator Cuff Tears. Anatomy
Copyright 2011 American Academy of Orthopaedic Surgeons Rotator Cuff Tears A rotator cuff tear is a common cause of pain and disability among adults. In 2008, close to 2 million people in the United States
More informationArthritis of the Shoulder
Arthritis of the Shoulder In 2011, more than 50 million people in the United States reported that they had been diagnosed with some form of arthritis, according to the National Health Interview Survey.
More information.org. Lisfranc (Midfoot) Injury. Anatomy. Description
Lisfranc (Midfoot) Injury Page ( 1 ) Lisfranc (midfoot) injuries result if bones in the midfoot are broken or ligaments that support the midfoot are torn. The severity of the injury can vary from simple
More informationSports Medicine. Assessing and Diagnosing Shoulder Injuries in Pediatric and Adolescent Patients
Sports Medicine Assessing and Diagnosing Shoulder Injuries in Pediatric and Adolescent Patients Sports Medicine at Nationwide Children s Hospital Nationwide Children s Hospital Sports Medicine includes
More information9/7/14. I do not have a financial relationship with any orthopedic manufacturing organization
I do not have a financial relationship with any orthopedic manufacturing organization Timothy M. Geib, MD Oklahoma Sports & Orthopedic Institute September 27, 2014 Despite what you may have heard, I am
More informationRadial Head Fracture Repair and Rehabilitation
1 Radial Head Fracture Repair and Rehabilitation Surgical Indications and Considerations Anatomical Considerations: The elbow is a complex joint due to its intricate functional anatomy. The ulna, radius
More informationSHOULDER ACROMIOPLASTY/ SHOULDER DECOMPRESSION
ORTHOPAEDIC WARD: 01-293 8687 /01-293 6602 BEACON CENTRE FOR ORTHOPAEDICS: 01-2937575 PHYSIOTHERAPY DEPARTMENT: 01-2936692 GUIDELINES FOR PATIENTS HAVING A SHOULDER ACROMIOPLASTY/ SHOULDER DECOMPRESSION
More informationEvaluating muscle injuries and residuals of shell fragment and gunshot wounds
Evaluating muscle injuries and residuals of shell fragment and gunshot wounds Training conducted by: Michael Fishman and Sandrine Fisher 1 Objectives To become familiar with the application of the rating
More informationCervical-Spine Injuries: Catastrophic Injury to Neck Sprain. Seth Cheatham, MD
Cervical-Spine Injuries: Catastrophic Injury to Neck Sprain Seth Cheatham, MD 236 Seth A. Cheatham, MD VCU Sports Medicine I have no financial disclosures Contact sports, specifically football, places
More informationOpen Rotator Cuff Repair Rehabilitation Program Methodist Sports Medicine Center, Indianapolis, IN Department of Physical Therapy
Open Rotator Cuff Repair Rehabilitation Program Methodist Sports Medicine Center, Indianapolis, IN Department of Physical Therapy Rotator Cuff Repair is a surgical procedure utilized for a tear in the
More informationRotator Cuff and Shoulder Conditioning Program. Purpose of Program
Prepared for: Prepared by: OrthoInfo Purpose of Program After an injury or surgery, an exercise conditioning program will help you return to daily activities and enjoy a more active, healthy lifestyle.
More informationShoulder. Clinical Assessment of the. The approach to a physical examination of the
Focus on CME at the University of British Columbia Clinical Assessment of the Shoulder When assessing shoulder pain, a structured physical examination, as directed by the patient s history, allows the
More informationCHAPTER 71. The shoulder and upper arm. 71.1 Introduction EXAMINING THE SHOULDER AND UPPER ARM
CHAPTER 71 The shoulder and upper arm 71.1 Introduction Most shoulder injuries are caused by a patient falling on the point of his shoulder, or on his outstretched hand. If he does this, he can dislocate
More informationRehabilitation Guidelines for Biceps Tenodesis
UW Health Sports Rehabilitation Rehabilitation Guidelines for Biceps Tenodesis The shoulder has two primary joints. One part of the shoulder blade, called the glenoid fossa forms a flat, shallow surface.
More information