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SHOULDER

Anatomy

The shoulder joint is the second largest and most mobile joint in the human body and can be easily understood if divided into three layers. view 

Shoulder Contusion

Trauma is the term used to describe injury. Trauma is classified by its severity depending on the amount of force used to cause the injury. view 

Shoulder Fractures

Shoulder Fractures or breaks in the shoulder can occur in the humeral bone, collar bone or the in shoulder blade.  view

Shoulder Dislocations

A shoulder dislocation is classified according to the direction of the dislocation (Anterior, posterior or multi-directional), the amount of force it took to dislocate the shoulder (Traumatic or Atraumatic), and whether it is accompanied by a fracture (fracture dislocation).  view 

Shoulder Arthiritis

Shoulder Arthritis is the loss of the cartilage cushion in the joint surfaces (blue section) that allows the smooth pain free gliding required during shoulder motion. view

Shoulder Nerve Compression Syndromes

Nerve compression syndromes are normally found in adults of all ages and it is rare to find nerve compression syndromes in patients younger than 20 years of age.  view 

Shoulder Tendon Disorders

Shoulder pain is the most common presenting shoulder complaint in an orthopedic practice.  view 

Shoulder Infection

The shoulder is one of the most well perfused areas of the human body and because of this ample blood supply to the shoulder which carries circulating white blood cells, offers excellent protection against infection, consequently making a shoulder infection a rare occurrence.  view 

Frozen Shoulder

A Frozen shoulder also called adhesive capsulitis is a condition presenting with shoulder stiffness and severe shoulder pain when shoulder motion is initiated. view 

Shoulder Tumor

Tumors are divided into benign and malignant types.  view 

SHOULDER FRACTURES

Pathology

Shoulder Fractures: breaks in one or more of the shoulders three bones:

  • Humeral bone (upper arm)
  • Clavicle (collarbone)
  • Scapula (shoulder blade)

The proximal humeral bone (portion of the upper arm closest to the body) is the third most fractured bone in the human body.

Common Causes of Shoulder Fractures:

  • A fall (from standing height or higher)
  • Sports injury
  • Motor vehicle accident

The most common shoulder fracture is the proximal humeral bone of elderly females due to a fall. Higher energy is required for fractures in individuals less than 40 years old due to their better mineralized bone strength.

Shoulder fractures are classified by the number of fracture parts present. For example, a broken arm can be called a 2 part, 3 part or 4 part proximal humeral fracture, with our without separation of the broken fragments (displacement).

shoulder-fracture2

Associated with shoulder fractures:

  • Dislocation of the glenohumeral joint (main component of shoulder)
  • Break in the glenoid (shoulder blade socket). Illustrated above.

 

Treatment

Unseparated (displaced) Shoulder Fractures

Fractures not separated (displaced) in either the humerus or glenoid can be treated with:

  • Sling for pain control
  • Controlled early passive motion exercises

X-rays will be used to assess the fracture healing. Typically, 8 weeks after injury active arm motion exercises begin. A Physical Therapist will guide the therapy protocol until normal activity can be achieved, usually six months after injury.

shoulder-fracture3

3 Part (or higher) Shoulder Fractures

If fracture fragments of the humerus number more than two and are significantly separated, the fracture is considered unstable and surgery is recommended. This enables the shoulder fracture to heal properly to useful arm function.

Surgery in Patients With:

Strong Bone Quality: Fractures are fixed with the use of modern plates and screws that lock to each other and hold the fragments together while healing.

Poor Bone Quality: A three or four part fracture, with or without a joint dislocation or a break involving the joint surface, is indicated for a shoulder replacement (hemi-arthroplasty).

Very Weak Bone Quality: When the patient is elderly and the bone is very weak with a poor likelihood of success with a hemi-arthroplasty, a reverse shoulder arthroplasty is the best first surgical option. Need a description of a reverse shoulder arthroplasty.

The standard fracture hemi-arthroplasty allows for the bone fragments to be fixed to the implant while the bone heals. Need a description of the implant.Implants are usually cemented in the humeral canal with cement called methylmethacrylate. Newer implants have recently been developed that do not require bone cement.

A fracture hemi-arthroplasty is a difficult operation and only those surgeons with the proper training who perform these operations on a routine basis should perform this surgery.