Inj. of shoulder and upper arm Fracture clavical In children easily united rapidly without any complication In adult this can be much more troble some inj.

Mechanism of inj. Fall on shoulder Fall on out starched hand

Common site midshaft Outer segment displace downward Inner segment displace upward

C.F The arm clasped to chest Immoblization Subcutanous lump Vas.inj. rare

Dx. X_ray AP veiw to shoulder Direction

RxRx Sling Until pain subsided(2-3)week

complication Early Pnemothorax Damage subclavian vessels Brachial plexus inj All above rare

late Malunion Stiffness Non union

Fracture scapula Mechanism of inj. Body direct or crushed inj. Neck blow or fall on shoulder. Corcoid process avulsion inj Acromian direct force. Glenoid occur with disl. Of shoulder.

C.f Arm held immobile Sever brusing overscapula and chest Sever truma inj.tochest,spine,abd,head

X-ray Plain x-ray CT.scan

RxRx Neck usually impacted,sling(2-3)wks. Glenoid depend on glenoid surface a.less than 25% Conservative b.more than 25% Surgical Body surgery is not indicated sling and early exercise Acromian conservative and early exercise

Acromio-clavicular disl. A cute inj. Is common and usually follows direct Trauma. Chronic sprain degenerative changes seen in athletic and working with jack – hammer and Vibrating tool

Mech. Of inj. Fall on the shoulder with the arm adducted may strain or tear the AC lig and upwards subluxation of the clavicle may occur. If the force is severe the CC lig may be torn ; resulting complete disl. Of the joint

classification Type 1 sprain Type 2 subluxation Type 3 disl.

X- Ray Ap, lat.,axillary veiw. Stress veiw 5 Kg. Defrantation between sub. And dislocation.

RxRx Sprain and sublaxation by sling (2 – 3 )weeks Displacement padding and bandaging if not control surgery

complication Rotator cuff synd. Unreduced dislocation. Ossification of lig. Secondary OA.

Dis. Sterno clavicular Un common Mech. Of inj. Lat. Compression of shoulder Ant. Dis. More common than posterior. Type of inj. Sprained, sublaxation and dis.

X- Ray Ap. Special oblique veiw CT. scan

RxRx Sprian and subl. No need Rx. Dislocation reduce

Dislocation of shoulder Occur commonly due to 1.Shollowness of glenoid socket. 2.Extraordinary range of movement.

Type of dislocation 1.Anterior dislocation 95% most common 2.Postior dislocation 3.Inferior

Ant. dislocation Common Mech. Of inj. Fall on the hand. Humers driven upward,tearing of capsule or avalsion of glenoid labrum.

C.f Sever pain Support arm with other hand Lateral boarder of shoulder Flat In thin person prominance the head under clavical

X-ray AP view 1.empty socket. 2.head medial to socket and below. 3.sss. Frature seen.

RxRx 1.Stimson method 2.Hippocrate method 3.Kocher met hod

After reduction x-ray taken to confirm redution And exclude fracture. Neurological Ex.to exclud axillary N. inj. Sling for 3wks under 30 years 1wk over 30 years Elbow and Finger exersise started early.

Complication Early 1.Rotator cuff synd. 2.N.inj Axillary,ulnar median. 3.Vascular inj.Axillary artery 4.Fracture,disl.

Late 1.Stiffness of shoulder 2.Unreduce dislocation 3.Recurrent dislocation 4.instability

Posterior dislocation Rare 2% Mech. Of inj Indirect force,internal rotation and adduction occur during fit and electrical shoch

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