Shoulder Injuries

Humerus fractures, shoulder dislocations, broken clavicles, shoulder separations and then some. We cover all the bases of acute shoulder injuries with sports medicine orthopedist Dr. Brett Andres. It’s also ERcast’s third anniversary, so raise a toast and thanks for listening.


Direct download podcast 

Links mentioned in the podcast introduction

Splint Like a Pro

Cunningham technique for shoulder reduction

Broomedocs podcast on suicide risk assessment

Whit Fisher’s frozen NG tube insertion technique

T-ring finger tourniquet

 

Which proximal humerus fractures need surgical repair?

There is no definite answer to this. New fixation technology gives results that were not possible a few years ago, so more and more of these are getting surgically managed. The main questions are whether or not the humeral head is still on top of the humerus and if the head articulates with the glenoid. I think of this in terms of an ice cream cone, with the humeral shaft the cone and the humeral head the ice cream. If the ice cream is still on the cone, it will probably heal OK. If the ice cream has fallen off the cone, that may benefit from surgical repair.

https://gmep.org/media/12253

https://gmep.org/media/12254

A split humeral head will have a poor outcome with chronic arthitis- may benefit from surgery

Displaced greater and lesser tuberosity fractures may look benign, but those are the attachment sites  of the rotator cuff. May benefit from surgery.

https://gmep.org/media/12256

Shoulder dislocations: How long to splint after reduction

Young patients, under 20, have a high re-dislocation rate (as high as 70%). Three weeks immobilization.

Age 20-45 will probably not dislocate again, but stiffness is a problem. Sling after reduction, but begin ROM when pain improves.

Older patients, 60 or greater, are unlikely to re-dislocate but have a higher incidence of rotator cuff repair. They probably don’t need prolonged immobilization, but do need follow-up to evaluate for rotator cuff injury.

Clavicle fractures: Which need surgery?

There is a high non-union rate for displaced fractures (no cortical contact).

Brett considers surgery if there is : no cortical contact, overriding 2cm, butterfly type fracture.

How should we immobilize clavicle fractures?

A sling should be sufficient. Some patients like the figure of eight, but it can rest on the fracture fragment and be irritating. A sling for a clavicle fracture is not like a cast- it doesn’t help with healing. Begin early ROM when the patient can tolerate.

Calcific tendonitis

Although a chronic problem, can cause acute intense pain. Calcium breaks loose and gets into the subacromial space, causing irritation. A patient can have so much pain that examination is difficult. A subacromial bursa injection may help to relieve symptoms.

https://gmep.org/media/12255

Subacromial bursa injection (courtesy of Larry Mellick, MD)

 

Comments

  1. Gabe Rose

    Not more than 1 hour after listening to this episode (en route to a shift on the train) did I get a shoulder pain present to the ED. I performed passive adduction to external rotation and--just as described--she winced, ouched, splinted, and moved with me. I looked back and found an XR done 8 months ago and lo and behold, it shows calcification. We talked calcific tendonitis, treated it appropriately, and sent her home happier. Thanks for sharpening my acumen, once again, just that much more!

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  3. Sunil Medapati

    A fracture is defined as a break in the continuity of a bone. A fracture can be the result of high force impact or stress,or by just a trivial injury in weak bones, such as osteoporosis, bone cancer or osteogenesis imperfecta.
    Causes of Fractures:
    Traumatic : Secondary to low or high energy trauma.
    Pathological : Secondary to trivial trauma in a bone, weakened by pathologies like osteoporosis, bone metastasis etc.
    Treatment of Shoulder Fractures:
    Straightforward sling or strap worn for three to two months, contingent upon the patient’s torment.
    Surgery, which may incorporate putting plates and screws or wires and sutures .This is all the more frequently required when there is damage to the glenoid (shoulder socket) or when broken bone pieces are seriously strange.

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