1. Saturday AM Sports/Orthopedic Clinic

2. Presentation Left Shoulder pain

3. Name some reasons for shoulder pain ?

4. Causes of shoulder pain Suprascapular nerve entrapement Shoulder instability Thoracic outlet syndrome Cervical radiculitis Bicipital tendonitis rotator cuff disease

5. Name all of the joints involved in the shoulder girdle complex?

6. 7 Joints in Shoulder Girdle Complex GH Joint Suprahumeral joint AC Joint Scapulocostal jt Sternoclavicular joint Sternocostal jt Costovertebral joint

7. Unstable joint? What structures causes the shoulder (glenohumeral) joint to be highly mobile but relatively stable

8. The relatively poor bony congruence between the gleniod and humeral head and a slack capsule

9. What structure provides the strongest support for the AC joint?

10. The coracoclavicular ligament which descends from the distal clavicle to the coracoid process. The ligament must be torn to produce the major stepdown of the acromion below the clavicle in grade 3 acromioclavicular joint injuries

11. What other causes of shoulder pain?

12. Can the pain be referred?

14. What else?

15. Pale Clammy Pain in epigastrum

16. Positive Kehr’s Sign What is it?

17. Left shoulder pain Free intraperitoneal blood Diaphragmatic irritation

18. Kehr’s Sign, neglected aid in rupture of the spleen New England Journal of Medicine

19. Name some other symptoms of spleen injury?

20. Splenic Injury Generalize abdominal pain Left shoulder pain Aggravated by deep pressure of left hypochondrium Tenderness to rectal palpation Slight increase in temperature FAST test

21. What is the most commonly injured viscous in blunt trauma?

22. Spleen the most commonly injured viscous in blunt abdominal trauma

23. Delayed rupture presenting as unstable angina pectoralis

24. What causes a delayed rupture spleen?

25. Causes of the delayed bleed? Tamponade (old blood clots) Subscapular hemorrhage Small tamponade forms clot on omentum or bowel laceration Subscapular hemorrhage may be present for several days before rupture of the capsule takes place

26. How long can the delayed rupture occur?

27. Delayed Less than an hour and Up to 14 days Several months 21% delayed

28. Journal of Trauma 2008 673 non operative spleen Mild – 12.5 heal Severe – 37 days 20% not heal after 3 months 10% worse as outpatient

29. What is the mortality?

30. Mortality of a simple spleen rupture is 1%

31. When would allow the player to return to sports?

32. Full return not until 6 months