SHOULDER to SHOULDER

MI Zucker, MD

A dr Z lecture

On common things of the shoulder that hurt

Views and Anatomy

• AP

• 30 degree oblique

Views and Anatomy

• Lateral Y

• Axillary

TRAUMA

Dislocation

• Among the most common joint dislocations

• 95% are anterior

Anterior Dislocation

• Three major complications:

• Hill-Sachs fracture• Bankart fracture• Greater tubercle

fracture

Posterior Dislocation

5% of shoulder dislocations

60% are missed initially

Why?

Because:

• The correct views were not done!

• ALWAYS get a LATERAL Y or an AXILLARY view -or both!

Luxatio Erecta

• A subtype of Anterior Dislocation with a higher incidence of neurovascular injury.

• Dramatic presentation: Arm is raised over head and locked!

Proximal Humerus Fractures

• Most common locations are surgical neck, anatomic neck, greater and lesser tubercles

Proximal Humerus Fractures

• Usually, elderly patient with osteoporosis, ground level fall.

• 80% can be treated with simple immobilization.

• The rest need closed or open reduction or joint replacement.

Acromio-clavicular Joint Injuries: The players

• Acromio-clavicular ligament

• Ac joint capsule• Coraco-clavicular

ligament

Allman Classification

• Grade I or sprain: occult radiologically

• Grade II or subluxation

• Grade III or dislocation

Allman Grade II

• Wide ac joint: over 7mm.

• Partial elevation of clavicle tip

• Normal cc ligament: less than 13mm

Allman Grade III

• Wide ac joint• Complete elevation of

tip of clavicle• Wide cc distance

Clavicle Fractures

• Allman Classification– Group I 80%

– Group II 15%

– Group III 5%

Clavicle Fractures Group I

80% of total.

Treated conservatively.

Most do very well.

Clavicle Fractures Group II

• 15%. Guarded prognosis; initially treated conservatively but may need delayed surgery

• Neer Type I: Intact cc ligament

• Neer Type II: Torn cc ligament

Allman Group III

• 5%. Head of clavicle• Conservative

management• Do well

Scapula Fractures

• Body• Glenoid• Processes

Scapula Fractures: Body & Glenoid

• Fractures of the body and glenoid can be easy or difficult to see

• CT commonly used to completely evaluate fractures

• Surgical management fairly common

Scapula Fractures: Coracoid and Acromion Processes

• Acromion fracture

Kid Fractures

• Salter-Harris physis injuries

• This is a displaced

SH I

Things that hurt that aren’t acute trauma

• Rotator cuff disease (impingement syndrome)• Calcific bursitis• CPPD disease• Osteoarthritis• Inflammatory arthritis• Septic arthritis/osteomyelitis• Malignancy• AVN

Rotator Cuff Disease

• AKA Impingement Syndrome

• Decades in the making: We only see it at Phase III when cuff is essentially gone

Calcific Bursitis

• AKA Hydroxyapatite disease

• Subdeltoid-subacromion bursitis

Osteoarthritis

• Primary is not common

• Usually, secondary to – Rotator cuff disease

– CPPD disease

Inflammatory Arthritis

• Rheumatoid arthritis and related entities

• Osteoporosis from hyperemia, erosions, joint destruction and little repair

Infection

• Infection of joint or bone or both

• Any destructive process that crosses a joint is most likely infection

Malignancy

• Osteolytic

• Osteoblastic

• Mixed

• Primary or metastatic

Avascular Necrosis

• Steroids• SLE• SCD• After severe humerus

head/neck fracture• Idiopathic

GOODBYE

• Copyright 2004

MI Zucker