Anatomy of the Shoulder

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Maude Marsh
7 years ago
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1 Anatomy of the Shoulder

2 Dislocations of the sternoclavicular joint Pathomechanism: fall on the outstreched upper extremity Classificatios: a. anterior : Clinical signs: prominence at the joint b. posterior: Clinical signs: indentation at the joint, tracheal or bronchial, vessel compression Diagnosis: clinical sings, X- ray, CT Therapy: 1. Closed reduction by lateral and posterior traction (a) 2. Sandbag between the scapulae and downward pressure on both shoulder (b) 3. Open reduction, joint capsule reconstruction in case of complications Sternoclavicular joint: discus,sternoclavicural,costoclavicular ligament

posterior: Clinical signs: indentation at the joint, tracheal or bronchial, vessel compression Diagnosis: clinical sings, X- ray, CT Therapy: 1.

3 Fracture of the clavicle Pathomechanism:fall on the outsrteched upper extremity ( hand) or on the shoulder and direct injury Classificatios: a. midle third fracture (2/3) Clinical signs: the outer fragment falls downward and inward, the inner fragment is draw upward by the sternocleidomastoid muscle b. lateral third fracture ( like dislocations of the acromioclavicular joint) Clinical signs: marked superior migration of the lateral end of the clavicle Diagnosis: clinical sings, X-ray

$midle third fracture (2/3) Clinical signs: the outer fragment falls downward and inward, the inner fragment is draw$

4 Dislocations of the acromioclavicular joint Pathomechanism: downward force on the acromion, fall on the point of the shoulder Classificatios: a. Tossy I. partial rupture of the acromioclavucular ligaments Clinical signs: the AC joint is swollen and tenderness b. Tossy II. rupture of the acromioclavicular ligaments Clinical signs: swelling and tenderness of the AC joint with superior migration of the lateral end of the clavicle c,tossyiii. Complete rupture of all ligaments ( acromioclavicular, coracoclavicular Clinical signs: marked superior migration of the lateral end of the clavicle the shoulder appears depressed when compared the opposite normal site

rupture of the acromioclavicular ligaments Clinical signs: swelling and tenderness of the AC joint with superior migration of the lateral end of the clavicle

5 Fracture of the clavicle Therapy: 1. Functional treatment 2.Closed reduction by tornister strap or figure eight clavicle strap 3. Open reduction and reconstruction plate fixation ( brachial plexus or vessel injury, open fracture, interposition, aesthetic indication) 4, Lateral third: Tension band fixation Bosworth screw

$injury, open fracture, interposition, aesthetic indication) 4, Lateral third:$

6 Dislocations of the acromioclavicular joint Diagnosis: clinical signs, X-ray, stress AP roentgenograms taken of both shoulders Therapy: 1. Functional treatment, range of motion excercises 2. Coracoid screw,tension band fixation of the AC joint

7 Fracture of the scapula Pathomechanism: blow on the shoulder, fall on the outstreched arm, direct trauma Classifications: a. glenoid fracture b. fracture of the acromion c. fracture of the coracoid process d. fracture of the body of the scapula Clinical signs: pain, swelling echimosis, limited glenohumeral joint funtion, associated thoracic injuries Diagnosis: clinical sings, X-ray, CT ( incase of joint fracture) Therapy: 1. Immobilsation, functional treatment, range of motion excercises 2. Open reduction, reconstruction of the articular surface and srew or plate fixation 3. Screw fixation of the acromion and coracoid process in young patiens

$fracture of the body of the scapula Clinical signs: pain, swelling echimosis, limited glenohumeral joint funtion, associated thoracic injuries Diagnosis: clinical$

8 X ray examination of the GH joint

9 Dislocation of the glenohumeral joint Pathomechanism: abduction and external rotation with a posterior force ( anterior dislocation) Classificatios: a. anterior or subcoracoid b. inferior or subglenoid c. posterior or subspinosus(2%) Clinical signs: deformity; coracoid process and acromion is more prominent, that usual, the joint is empty, the humerus is fixed in abduction, adduction and the internal rotation is impossible and painful Diagnosis: clinical signs, X-ray (associated fractures) axillary view is important in detecting posterior dislocation Therapy: 1, Reduction by Artl method ( backed chair ) 2, Reduction by Hippocrates manipulation immobilisation for 1-3 weeks

$abduction, adduction and the internal rotation is impossible and painful Diagnosis: clinical signs, X-ray (associated fractures) axillary view is important in detecting$

10 Humeral head anatomy ( Codman )

11 Fractures of the proximal humerus Pathomechanism:fall on the outstreched arm,direct fall on the shoulder, osteoporosis Classifications: Neer s classification: a. anatomical neck b. surcgical neck c, greater tuberculum d, lesser tuberculum Clinical signs: pain, deformity; loss of function ecchymosis, local tenderness, crepitus Diagnosis:clinical signs, X_ray

14 Positioning for surgery

15 Positioning for surgery

16 Therapy: 1. Functional treatment, pendulum excercises ( according Poelchen ) 2. Sling for 1-3 weeks, early physiotherapy and active movements 3. Closed eduction and percutaneous fixation (K-wires, screws) 4, Open reduction and internal fixation( screws T-buttress plate, tension band fixation, MITEK anchor)

26 Rotator cuff failure, impingement syndrome Pathomechanism: traumatic, degenerative origin Classifications: a. < 2cm b. > 2 cm Clinical signs: pain ( at night ), painful arc, loss of motion Diagnosis: clinical examination, X-ray, arthrography, ultrasonography, MRI, arthroscopy Therapy: 1. Functional treatment ( a ), NSAID 2. Operative reconstuction ( b ) - open procedure, arthroscopic procedure 3. Acromionplasty ( degenerative )

27 Classification ac. AO

29 Fractures ad dislocations of the upper extremity Humeral shaft fracture: Indication for surgery Absolut: multiple trauma open fracture bilateral humeral fracture pathological fractures floating elbow vascular injury radial nerve palsy after closed reduction non union

30 Fractures and discolations of the upper extremity

31 Fractures and discolations of the upper extremity

32 Fractures ad dislocations of the upper extremity Humeral shaft fracture: Indication for surgery relative: long spirale fracture transverse fracture brachial plexus injuries primary nerve palsy inability to maintain reduction neurologic deficits, Parkinson's disease obesity

33 Fractures and discolations of the upper extremity Humeral shaft fractures Non operatíve treatment Between 70-80% of fractures can be managed non-operatively Acceptable deformity: 20 AP angulation 30 varus angulation 30 mm shortening hanging cast brace

SCAPULAR FRACTURES. Jai Relwani, Shoulder Fellow, Reading Shoulder Unit, Reading.

SCAPULAR 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