Shoulder conditions

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Author:
sgustafson
ID:
74429
Filename:
Shoulder conditions
Updated:
2011-03-30 23:59:30
Tags:
shoulder probs
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Description:
week2 blk4 clinical integration
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  1. 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
  2. Humerus midshaft fracture - pathologic
    • neoplasms, osteomyletis, Paget's disease
    • may cause injury to radial nerve: loss of sensation over dorsum, weakness w/wrist extension
  3. Clavicle fracture
    • most common childhood fracture - not completely ossified til late teens
    • 80% occur in middle third of clavicle, medial to coraclavicular ligament
  4. 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
  5. 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
  6. 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
  7. 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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