Chapter 13 – The Shoulder and Upper Arm Pages

Question #1  What are the most important pathologies to rule out?  Why?

On-Field Evaluation of Shoulder Injuries  Most important to rule out  Fractures  Dislocations  Distal Pulse  Evaluation of cervical and/or thoracic spine

Question #2  Describe equipment considerations when evaluating a shoulder on the field.

Equipment Considerations  Familiarize yourself!  Palpation Under the Shoulder Pads  Figure 13-36, page 485  Removal of the Shoulder Pads  Figure 13-37,page 486

On-Field History  Location of Pain  Shoulder vs. brachial plexus pathology  Mechanism of Injury

Question #3  Describe an on-field inspection of the shoulder.

On-Field Inspection  Arm Posture  Arm splinted against the torso  Clavicular fracture, AC joint pathology  Arm hanging limply  Brachial plexus pathology  Arm “locked”  GH dislocation  Gross Deformity

Question #4  Describe on-field palpation of the shoulder.

On-Field Palpation  Position of humeral head  AC joint alignment  Piano key sign  Clavicle  SC joint  Humerus

Question #5  Describe on-field functional tests for the shoulder.

On-Field Functional Tests  Rule out dislocation or fracture  Apley’s Scratch test

Initial Management of On- Field Shoulder Injuries  Figure 13-38, page 487

Question #6  Describe scapular fractures.

Scapular Fractures  Body of scapula, glenoid fossa, glenoid neck, coracoid process  Secondary to GH dislocation  S/S similar to rotator cuff pathology  Immobilization/transportation

Clavicular Injuries  Clavicular Fractures  Immobilization, referral to physician  SC Joint Injuries  Potential compromise to underlying structures from posterior dislocation  Immobilization, transportation (supine)

Clavicular Injuries  AC Joint Injuries  Figure 13-39, page 488  Nonsurgical treatment  Protection during activity

Question #7  Describe GH dislocations.

GH Dislocations  Monitor distal pulses, circulation, sensation  Immobilization  Keep wrist and hand exposed  Immediate transportation  Reductions performed by physician

Question #8  Describe humeral fractures.

Humeral Fractures  Extreme pain, dysfunction, obvious deformity  May be secondary to GH dislocation  Immobilization  Keep wrist and hand exposed  Immediate referral to physician