1. Shoulder Injuries Diagnosis & Treatment By Don Hudson, D.O., FACEP/ACOEP

2. Shoulder Injuries & what to consider Rotator Cuff Injury Rotator Cuff Injury Anterior Dislocation Anterior Dislocation Posterior Dislocation Posterior Dislocation Clavicle Fracture Clavicle Fracture Humerus Fracture Humerus Fracture Vascular & Neurological Injuries Vascular & Neurological Injuries Ligament injuries Ligament injuries

3. Most Common I will go over the most common injuries first. I will go over the most common injuries first. The anterior shoulder dislocation The anterior shoulder dislocation Clavicle fracture Clavicle fracture

4. Anterior Dislocations These usually occur because of a forceful downward motion against resistance with the humerus up & rotating These usually occur because of a forceful downward motion against resistance with the humerus up & rotating An example is a lay-up shot in basketball that is blocked by a downward motion from another player. An example is a lay-up shot in basketball that is blocked by a downward motion from another player. Of course any similar mechanism of injury will accomplish the same dislocation. Of course any similar mechanism of injury will accomplish the same dislocation.

5. Clavicle fractures These occur because of axial loading along the long axis of the clavicle These occur because of axial loading along the long axis of the clavicle Direct blow to the clavicle anterior to posterior Direct blow to the clavicle anterior to posterior Depending on the patients age it will fracture (in younger patients) in medial 1/3 Depending on the patients age it will fracture (in younger patients) in medial 1/3 In older patients it usually fractures in the lateral 1/3 In older patients it usually fractures in the lateral 1/3

6. Posterior Dislocations These usually occur because of a anterior to posterior motion, i.e. fall on an outstretched arm, motor vehicle accident, etc. These usually occur because of a anterior to posterior motion, i.e. fall on an outstretched arm, motor vehicle accident, etc. These frequently have neurological complications. These frequently have neurological complications.

7. Ligament Injuries Ligament injuries are caused by normal motion taken beyond physiological limits Ligament injuries are caused by normal motion taken beyond physiological limits Acute injuries swell, bruise & hurt Acute injuries swell, bruise & hurt Chronic injuries defined by crepitence & pain mainly because of scarring. Chronic injuries defined by crepitence & pain mainly because of scarring. Early ROM helpful to prevent chronic state Early ROM helpful to prevent chronic state ROM may decrease chronic pain ROM may decrease chronic pain

8. Shoulder Anatomy

9. More Shoulder Anatomy

11. Vascular Anatomy

12. More Shoulder

13. Potential Associated Injury

14. Anterior Dislocations

15. Posterior Dislocations

16. Now what? Your worries are? Your worries are? Humerus Fracture Humerus Fracture Brachial Plexus injury Brachial Plexus injury Clavicle Fracture Clavicle Fracture Isolated vascular injury Isolated vascular injury

17. The thought is to do no harm The reduction is done for pain relief. The reduction is done for pain relief. Also for improvement of vascular or neurological compromise Also for improvement of vascular or neurological compromise The longer it is out of socket the longer rehabilitation will take The longer it is out of socket the longer rehabilitation will take Lots of soft tissue ischemia is occuring Lots of soft tissue ischemia is occuring

18. Reductions There are a lot of techniques available. There are a lot of techniques available. The two that are the least traumatic are the scapular rotation and “lifting of the arm. The two that are the least traumatic are the scapular rotation and “lifting of the arm. The lifting procedure takes 2 fingers. The lifting procedure takes 2 fingers. The scapula rotation is a little more complicated. The scapula rotation is a little more complicated.

19. Anesthesia This can range for none to general depending on the patient. This can range for none to general depending on the patient. Develop good rapport with them and explain the process and the amount of time when pain will be high. Develop good rapport with them and explain the process and the amount of time when pain will be high. Most choose no pain meds. Most choose no pain meds.

20. Anesthesia When I use it I prefer a local joint block with 5-8 cc of a ½ Marcaine & Lidocaine either with or with out epi. When I use it I prefer a local joint block with 5-8 cc of a ½ Marcaine & Lidocaine either with or with out epi. IV meds include MS, Fentenyl, Valium, Versed, Ketamine or Demerol. IV meds include MS, Fentenyl, Valium, Versed, Ketamine or Demerol. Consider how long it takes to recover and how long they may be in the ER/clinic. Consider how long it takes to recover and how long they may be in the ER/clinic.

21. PRACTICE SESSION Traction counter traction techniques Traction counter traction techniques SAGER technique (why not to use) SAGER technique (why not to use) Scapular Rotations Scapular Rotations Humeral lift techniques Humeral lift techniques What to do if these do not work, what do you consider the reason & how do you correct it. What to do if these do not work, what do you consider the reason & how do you correct it.

22. Problems & Rehabilitation These take a while to heal & tighten up These take a while to heal & tighten up 4-6 weeks is average. 4-6 weeks is average. Repeated subluxations frequently need surgery Repeated subluxations frequently need surgery Narcotics rarely needed unless a complicated reduction or other issues of trauma needs to be considered Narcotics rarely needed unless a complicated reduction or other issues of trauma needs to be considered