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Surgical neck fracture
- Osteoporotic pts at risk, direct impact to shoulder or falling on an outstretched hand
- Axillary nerve damaged: deltoid sensory changes, weakness w/ abduction
- EMG or NCS may be needed
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Humerus midshaft fracture - pathologic
- neoplasms, osteomyletis, Paget's disease
- may cause injury to radial nerve: loss of sensation over dorsum, weakness w/wrist extension
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Clavicle fracture
- most common childhood fracture - not completely ossified til late teens
- 80% occur in middle third of clavicle, medial to coraclavicular ligament
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Shoulder instability & dislocation
- <1/3 of head of humerus is in glenoid cavity
- ligament laxity: developmental, injuries, degeneration - most commonly inferior glenohumeral ligament
- 95% are anterior dislocations, direct force or repeated activity w/ abduction & external rotation
- Muscle spasm in attempt to stabilize shoulder
- Asymmetry, diffuse tenderness, very limited range of motion
- Prognosis good if no neural deficits, unless labrum is torn
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Acromioclavicular (AC) joint injuries
- AC joint sprain: AC joint ligaments are affected, but coracoclavicular ligaments are not. Rest and arm sling 6-8wks
- AC joint separation: severe pain, surgery needed
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Adhesive capsulitis
- chronic immobility of shoulder joint causes scarring, thickening, inflamm of joint capsule
- deep, dull ache, stiffness
- external rotation first motion to be affected
- physical therapy, US
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Shoulder impingement syndrome
- aka rotator cuff tendonitis, supraspinous tendonitis, subacromial bursitis, calcific bursitis
- degenerative process, exacerbated by overuse - ischemia, microtears
- positive Hawkin's sign, Neer's sign
- limited abduction/flexion, internal rotation will increase pain
- Joint space narrowing, subchondral bone sclerosis
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