1. SHOULDER to SHOULDER MI Zucker, MD

2. A dr Z lecture

3. On common things of the shoulder that hurt

4. Views and Anatomy AP 30 degree oblique

5. Views and Anatomy Lateral Y Axillary

6. TRAUMA

7. Dislocation Among the most common joint dislocations 95% are anterior

8. Anterior Dislocation Three major complications: Hill-Sachs fracture Bankart fracture Greater tubercle fracture

9. Posterior Dislocation 5% of shoulder dislocations 60% are missed initially Why?

10. Because: The correct views were not done! ALWAYS get a LATERAL Y or an AXILLARY view -or both!

11. Luxatio Erecta A subtype of Anterior Dislocation with a higher incidence of neurovascular injury. Dramatic presentation: Arm is raised over head and locked!

12. Proximal Humerus Fractures Most common locations are surgical neck, anatomic neck, greater and lesser tubercles

13. Proximal Humerus Fractures Usually, elderly patient with osteoporosis, ground level fall. 80% can be treated with simple immobilization. The rest need closed or open reduction or joint replacement.

14. Acromio-clavicular Joint Injuries: The players Acromio-clavicular ligament Ac joint capsule Coraco-clavicular ligament

15. Allman Classification Grade I or sprain: occult radiologically Grade II or subluxation Grade III or dislocation

16. Allman Grade II Wide ac joint: over 7mm. Partial elevation of clavicle tip Normal cc ligament: less than 13mm

17. Allman Grade III Wide ac joint Complete elevation of tip of clavicle Wide cc distance

18. Clavicle Fractures Allman Classification –Group I 80% –Group II 15% –Group III 5%

19. Clavicle Fractures Group I 80% of total. Treated conservatively. Most do very well.

20. Clavicle Fractures Group II 15%. Guarded prognosis; initially treated conservatively but may need delayed surgery Neer Type I: Intact cc ligament Neer Type II: Torn cc ligament

21. Allman Group III 5%. Head of clavicle Conservative management Do well

22. Scapula Fractures Body Glenoid Processes

23. Scapula Fractures: Body & Glenoid Fractures of the body and glenoid can be easy or difficult to see CT commonly used to completely evaluate fractures Surgical management fairly common

24. Scapula Fractures: Coracoid and Acromion Processes Acromion fracture

25. Kid Fractures Salter-Harris physis injuries This is a displaced SH I

26. Things that hurt that aren’t acute trauma Rotator cuff disease (impingement syndrome) Calcific bursitis CPPD disease Osteoarthritis Inflammatory arthritis Septic arthritis/osteomyelitis Malignancy AVN

27. Rotator Cuff Disease AKA Impingement Syndrome Decades in the making: We only see it at Phase III when cuff is essentially gone

28. Calcific Bursitis AKA Hydroxyapatite disease Subdeltoid- subacromion bursitis

29. Osteoarthritis Primary is not common Usually, secondary to –Rotator cuff disease –CPPD disease

30. Inflammatory Arthritis Rheumatoid arthritis and related entities Osteoporosis from hyperemia, erosions, joint destruction and little repair

31. Infection Infection of joint or bone or both Any destructive process that crosses a joint is most likely infection

32. Malignancy Osteolytic Osteoblastic Mixed Primary or metastatic

33. Avascular Necrosis Steroids SLE SCD After severe humerus head/neck fracture Idiopathic

34. GOODBYE Copyright 2004 MI Zucker