Shoulder

Injuries I
Dr. Abdullah Raizah
 Wwi # b - ④ & lit *

idly
Shoulder Injuries I
•

• Clavicle fractures
• Scapula fractures
• Proximal humerus fractures
• Rotator cuff tears
÷÷÷÷÷÷÷÷÷÷
: : ÷:÷÷÷:i: : i:
tendons :O
Crocoid forms the attachment for §

supra spinetail Ant Aspect

spinets
.

supra of greater Tubresihg

fossa

infra sonatas
? tendons :
inl.raseinm.ms
Greater tuberosity forms the attachment d.
fossa

:÷::÷÷::::::::÷::.::::÷÷i
3 . Ferg's minor ceosteriorty ) External rotation only .
 Shoulder Anatomy
• Bony Anatomy

.÷ .
.
fossa
supra spinors
i
. 9

Cro
'

:
fossa
- - - - - - .
⑦ infra
spinal
- ons

a
Tf I

①
.

'

of
snuggled i
scapular → The origin
Ms •
A lateral border
i subscapular is .

form the attachment

p
-
body a a. teres minor

f. *
a

Bicep itch groove p

•
A
•

&
d
g

The lesser and greater tuberosity

plays an important role in shoulder function , Why ? ⑦
Because they form the attachment for the rotator cuff Ms .
Rotator cuff muscles :S I T S
E. pathology ‫ أو ال‬function ‫•مرة مهمة سواًء في ال‬

termini:S:
÷:÷÷÷!:&:
partial or complete tear and that’s will ‫•ممكن يحصل‬

::÷÷÷n:
erase in sein..
affect the shoulder function significantly
.very symptomatic (pain-weakness) ‫• املريض راح يكون‬

• Muscular Anatomy
 -0
• Common injury as it's superficial bone + Not covered by lots of
muscle Exposed to injuries
• The clavicle is curved it has a lazy S shape the middle 1/3rd
sustain stress more than other and it’s the commonest fracture area.

§ Clavicle Fractures:
üMechanism of injury: should We see all the clavicle from
commonest
① direct fall on the stemo.daviadarg.int → Acromioddvicalar J
.

is by direct ② f 7. completely
impact shoulder, direct impact, displaced fx from

f
or fall on outstretched Steno

to the
elavicalar
Acromio
go int
clavicle

hand indirect
Joint .

-
• completely displaced

üSymptoms and Signs: fx from the middle

} rt clavicle

Movement difficulty pain, prominence at

.

fracture site, examine: k s

skin, neurovascular bad Inspiction

structures and lungs Palpation
ROM
fx)
Special fest Cro special test for clavicle

Detailed Neurovascular Ex .
•We treat most of the clavicle fx Non-operative (pain medication and sling 2-3
weeks then the patient will start physiotherapy gradually and usually it will heal.
• In the clavicle complete displacement is NOT and indication for fixation.

üTreatment:
vMost clavicle fractures
heal nonsurgically using
-
analgesics and sling
Even after healing there will be a
bony prominence Although
it's still better than the surgical scar !

& vSurgical indications:

gmo
open fracture,
neurovascular injury,
floating shoulder and
Kot skin tenting

①
• An absolute INDICATION
• It differs from the bony prominence which occur in
most clavicular fx. While in skin tenting there is
iii. :: :::: ::c::::: ::::S is:÷:
i " a. screw
displacement of other clavicular end and it's just
lying under the skin so if we leave it with time it will
leads to pressure and ulcer=The skin will open.
In of will do I surgy g
• case surgy we
A. ORI f

2- After 9.12 months to remove the plate and screws .

 ⑧ Body ② Neck ③ Glenoid
principle applied

s:::i÷÷÷÷:÷÷÷÷
to
of them * Same
* We treat most
* Well covered by the for few weeks ang intra
articular FX →

consecrating (sling a -

rotatorcuff and it

:÷÷÷÷÷÷÷÷÷÷÷÷÷÷÷
with NO need to interfere .

Angulation 745 * We fix it with screws only as

there's no room for plate

we
usually fix it with plate and screws

§ Scapula Fracture:
üMechanism of injury: RTA

vMostly due to high

-

- fall from hight

energy trauma
vIndirect injury: fall on
outstretched arm
vDirect trauma
vShoulder dislocation
may cause glenoid
fracture Ant dislocation mostly .

MP
op-
Always think about other possible associated injuries
he mothorax mediastinum injuries
like rib fx -
pneumothorax -
-

cervical and spinal injuries .

 rule it out
üPossible associated injuries (80-90%) Always

vRibs fractures
v sternum injury
vPneumothorax
vPulmonary contusion
vNeurovascular injuries
vSpine injury

üSymptoms and Signs:

Pain, tenderness and reduced range of motion.
Evaluate for other associated injuries
üTreatment:
vScapular body fracture usually heal nonoperatively

vSurgical fixation for displaced intraarticular fracture or

scapular neck fracture with significant displacement or
angulation and floating shoulder
 It’s the fx. happening around the surgical or anatomical Neck of the humerus bone

f
- -

§ Proximal Humerus
Fracture:
üProximal humerus
①
4. Parts : composed of head, -

② ③
greater tuberosity, lesser
④
-
-

tuberosity and proximal

=
-

shaft
üThe muscles attachment
will affect the
displacement of the
-

fragments
If there was fx .
at greater tuberosity with displacement
Where will go in which direction and
it
by which tendon
?
Grate shaft

sueaseinetus-jeitj.d.idsmar.T.am?7nidbJ
:::i÷÷÷
i

lesser ÷÷÷÷÷÷:
subscapularis→Mcdid2# ms .
action
s
.
 there head ( Anatomical neck the worget) to 100% Chance of A- Vascular necrosis
*If was a
significant displacement of humeral are up .

.int:0
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üMajor blood supply to
humeral head is from Limited

anterior and posterior

*
A
Branches of #
The main
one

circumflex humeral artery

the Axillary artery

üMechanism of injury:
vFall onto outstretched
arm, it could be a sign of
osteoporosis in old
patients

vFall on the shoulder

mechanism of
injury go
vHigh energy injury in
young patients
.÷÷÷fi:1?i: :. . . . .fi i:i : issiniu.:.:i: mi . I
 üSymptoms and Signs:
Patient holds his arm in adducted position using other
t hand, pain, swelling, ecchymosis, tenderness and painful
range of motion.

Always Examine the neurovascular structures thoroughly

a
 Accepted displacement
* Humeral head displaced or dislocated → indication for surgery
.

superiority up to
→ 5M only
* Greater tubresits displaced ↳ contrary up to gem only
if more → Indication for surgery .

* lesser tuberosity displaced → you need to fix it because of subscapularis attachment

üTreatment:
vMostly treated
nonoperatively using
sling 2- 3 weeks gradual +
exercise

vSurgical treatment for

displaced and angulated
fractures:
Make sure the et hes strong
§ Close reduction and k-
*
←
.

bone ( suitable for Yonge and healthy Pt )

.

wire fixation
* Best choice for elderly ←
§ Open reduction and
internal fixation using proximal numerous locking plate
plate and screws
§ Hemiarthroplasty 8

⑦ ? Main indication
.im?aindneua.Isj.ng,g.:g;
@DisplayOparts.comge.ana.3Ot3isbatYwedeYeineIh.n
.

② Displaced head split

 * head dselaced with split

Axial CT

tt → hemi arthroplasty

When we consider it displaced ?

↳So greater tr .
+ tendon I @j -
d
*
greater T

}
• .

T > 1cm *
lesser I ⇐ f
a. khsseaedr
'
T
subscapularis ←
.

stem Shaft t.kb.jo

Angulation
+
: x. s

b 0J
450 or more jaw Bone graft
-
function I ←jg Healing ←
Very Hmp 80% are

i÷÷:÷÷÷÷:÷÷
→

Rotator cuff pathologies

Chinnici:c
" com 's
@
.

§ Rotator Cuff Tear:

ü Composed of: supraspinatus,
infraspinatus, subscapularis
and teres minor

üOriginate from scapula and

insert into greater tuberosity
and lesser tuberosity
* The most common tendon to be
injured is supra spinal ons
-
either by .

.
tendinitis; ,car .

→ so that will cause pain and weakness in shoulder abduction

* If I nfraspinatoug pain and weakness in Extermination

* If Teres minor Same 9

Me Rotator cuff Stabia the shoulder so it will be affected

depending on which muscle is affected .
 üMechanism of injury:
§ Overuse ( old age ) 750 years

§ Trauma:
ü Fall on outstretched arm
ü Post anterior shoulder dislocation in patients older than 40 yrs

ipsilateral neck
üSymptoms and Signs: and

q
-

Shoulder pain radiating to the arm, pain at night, pain with

overhead activities, waisting, weak abduction/ external -

rotation/ internal rotation

-

* in shoulder pain think of other anger rather than the shoulder it self .

Radiological invistioyation ooo

① MRI better)

② Us
 Suture AnKers → it's inside the bone
with non absorbable suture
.

üTreatment: 6.7 tendons I 1¥ go

,

r
①
§ Nonoperative initially: analgesics
(antiinflammatory ), ③
⑦
physiotherapy and injections
↳ Sub acromion cortisone

injection .

§ Surgical treatment: indicated

when nonoperative treatment
failed.
Surgical repair of the torn tendon

* In traumatic potato cuff tear we suggest operative tt .

from

the (immediately)
beginning
Investigations for Shoulder Injuries -

Rib
scapula
-

of

• AP chest x-ray
part
glenoid
-

-
clavicle

• Trauma shoulder series:

② ③
⑦
AP, lateral and axillary mcdialicatim
of lateral part
g.

views any shoulder injury

→
for

• Special x-rays → for specific area

Axial CT

• CT-scan * for
MRI
bony details

T -
tendon
e

@ z

• MRI * for soft tissue

] →
ruptured
 ‫🌿💛‬

‫‪Thank you‬‬
‫"إن النجاح الذي نحققه اليعتمد دائًما على موهبة أو ذكاء‬
‫خارق‪ ،‬و إنما يعتمد في األغلب على قرار بسيط‪ ،‬قرار بأن‬
‫"‬ ‫نمضي قدًما في طريقنا نحو تحقيق هدف‬