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Clavicle fractures are very common injuries in adults (2–5%) and evaluation and management of surgical treatments in relationship with the gravity of injuries. . series, consisting of an AP, scapular “Y”, and axillary lateral view. . Adequate counseling regarding the risks, benefits, and likely results of. - Explore Dehis mesd47's board "Shoulder.. clavicle. Guelph massage therapy levator scapula muscle Back Pain Exercises, Scapula, Upper The Relationship Between Headaches and Stress Workout Board, Workout Belt, . Orthopedics Today | The management of clavicle fractures has dramatically changed Also, the posterior view is where the (static and dynamic) scapular winging can . Preoperative counseling is important for patients electing operative intervention. . He has indicated he has no financial relationship with any company or.
There are many causes of shoulder pain. For most people, shoulder pain will improve over time with appropriate treatment. Shoulder pain is common in our community.
In younger people, shoulder pain is more likely to be due to an accident or injury. However, as you get older, natural wear and tear occurs in the shoulder joint and the rotator cuff tendon. Over time, this may become persistent pain. The good news is that with appropriate treatment shoulder pain will improve so you can get back to doing the things you enjoy.
The shoulder The shoulder is a complex, highly mobile structure made up of several components. There are two joints in the shoulder: Strong connective tissue forms the shoulder capsule. This keeps the head of the humerus in place in the joint socket. The joint capsule is lined with a synovial membrane. It produces synovial fluid which lubricates and nourishes the joint.
Strong tendons, ligaments and muscles also support your shoulder and make it stable.
What causes shoulder pain? There are many causes of shoulder pain and not all of these are due to problems of the shoulder joints or associated structures. Osteoarthritis Cartilage is a smooth, cushiony tissue that covers the ends of bones where they meet in a joint. Healthy cartilage helps your joints move smoothly.
Over time cartilage can become worn, or it may become damaged due to injury or an accident, leading to the development of osteoarthritis. Inflammation of the shoulder capsule The synovial membrane of the shoulder may become inflamed — this is called 'synovitis'. Synovitis may occur as a result of another condition for example, rheumatoid arthritis or it may happen as a result of an injury, or the cause may be unknown.
Frozen shoulder 'adhesive capsulitis' is a condition that occurs when the shoulder capsule thickens and becomes inflamed and tight.
There may also be less synovial fluid to lubricate the joint. As a result, the shoulder becomes difficult to move. Frozen shoulder may occur as a result of another condition if the shoulder has been immobilised for example, due to surgery or injury. Sometimes the cause of shoulder pain may not be known. Inflamed bursa Pain associated with an inflamed bursa is also common in the shoulder. A bursa is a small fluid-filled sac that reduces friction between two structures, such as bone, muscle and tendons.
In the shoulder, the bursa that sits between the rotator cuff tendon and the bony tip of the shoulder acromion can become inflamed, most commonly with repetitive movements.
Injuries and sprains Ligaments are soft tissues that connect bones to bones. Younger individuals often sustain these injuries by way of moderate to high-energy mechanisms such as motor vehicle accidents or sports injuries, whereas elderly individuals are more likely to sustain injuries because of the sequela of a low-energy fall 6.
Although a fall onto an outstretched hand was traditionally considered the common mechanism, it has been found that the clavicle most often fails in direct compression from force applied directly to the shoulder. Classification A number of classification systems have been proposed to aid in the description of clavicle fracture patterns for clinical and research purposes 1 To date, most modern clavicle fracture classification systems are primarily descriptive and not predictive of outcome.
The first widely accepted classification system for clavicle fractures was described by Allman 9 in Fractures were classified based on their anatomic location in descending order of fracture incidence. Type I fractures occur within the middle third of the clavicle, whereas type II and type III fractures represent involvement of the lateral and medial thirds, respectively. Fractures of the lateral third of the clavicle were further sub classified by Neer, 10 recognizing the importance of the coraco-clavicular CC ligaments for the stability of the medial fracture segment.
A type I lateral clavicle fracture occurs distal to the CC ligaments, resulting in a minimally displaced fracture that is typically stable.
Type II injuries are characterized by a medial fragment that is discontinuous with the CC ligaments. In these cases, the medial fragment often exhibits vertical instability after loss of the ligamentous stability provided by the CC ligaments. Type III injuries are characterized by an intra-articular fracture of the acromio-clavicular joint with intact CC ligaments.
Shoulder pain - Better Health Channel
Although these fractures are typically stable injuries, they may ultimately result in traumatic arthrosis of the acromio-clavicular joint. A more subtle fracture may require special radiographic views for identification and may be mistaken for a first-degree acromio-clavicular joint injury.
A more detailed classification system Edinburgh classification was proposed by Robinson 4. Similar to earlier descriptions, the primary classification is anatomically divided into medial type Imiddle type IIand lateral type III thirds.
Each of these types is then subdivided based on the magnitude of fracture fragment displacement.Scapula and Clavicle - Shoulder Girdle - Anatomy Tutorial
Type I medial and type III lateral fractures are further subdivided based on articular involvement. Subgroup 1 represents no articular involvement, and subgroup 2 is characterized by intra-articular extension. Similarly, type II middle fractures are sub-categorized by the degree of fracture comminution.
Simple or wedge-type fracture patterns make up subgroup 1, and comminuted or segmental fracture patterns represent subgroup 2. Craig 11 further modified Neer type II lateral clavicle fractures by stressing the importance of the conoid ligament and separately classifying intra-articular and pediatric clavicle fractures.
Evaluation Individuals with clavicle fractures will almost uniformly report an episode of trauma that has resulted in acute shoulder pain 2. Determining the mechanism is critical; while simple falls often produce isolated fractures, the high-energy mechanisms seen in the younger population can produce associated rib, scapular, or ipsilateral upper extremity fractures 2. Additionally, pneumothorax, hemothorax, and nerve and vascular injury have all been reported in association with clavicle fractures On examination, ecchymosis and a prominence over the fracture site may be observed.
Skin breaks or skin tenting must be identified, as both are indications for emergent operative treatment.
Palpation along the subcutaneous border of the bone should reveal an area of tenderness and potential step-off of the normally smooth contour. Attempted range or motion of the shoulder will be limited and produce pain and even palpable crepitus. We typically defer a thorough range-of-motion examination at the initial visit.
A neurovascular examination is essential. Motor and sensory function of the radial, ulnar, median, and axillary nerves should be confirmed. The radial pulse should be palpated and capillary refill compared with the contralateral side. Additional work-up should consist of a minimum of 2 radiographic views. For Allman Group II lateral fractures, an axillary view should be obtained to determine if there is AP displacement of the fracture fragments.
Additionally, if there is a question regarding disruption of the CC ligaments, a weighted view can easily be obtained at the time of initial radiographs.
A computed tomography CT scan may be required to determine the direction of displacement of Group III medial fractures, as posterior displacement risks injury to underlying neurovascular structures. Computed tomography scanning may also be helpful in the setting of nonunion or malunion, but are not typically a part of the initial evaluation.
Conservative treatment Conservative or non-surgical treatment is the norm for middle-third clavicle fractures, and is recommended for not displaced fractures 14 given the generally low incidence of non-union after conservative treatment of these fractures with rates ranging from 0.
There appears to be no consensus on the optimal duration of immobilization; some have recommended two to six weeks 13 ; 18 — Often no subsequent therapy is suggested to the patient. Sometimes, however, a patient will require stretching exercises to regain motion.
We prefer to follow the patient with a structured rehabilitation in order to have a satisfactory outcome for most patients.