MANUAL MINORS
From the perspective of an emergency physician working in an emergency department, the shoulder is a complex and highly mobile joint that is prone to various injuries due to its range of motion and anatomical structure. Below are the most common shoulder injuries and their management:
Category | Description |
|---|---|
Fractures | |
Clavicle Fracture | Fracture in the upper chest caused by direct trauma or a fall onto the shoulder. Causes intense pain, swelling, and visible deformity. Managed with immobilisation or surgery based on severity. |
Proximal Humerus Fracture | Fracture at the upper end of the humerus near the shoulder, common in the elderly due to falls. May involve the humeral head or tubercles. Treatment includes splinting or surgery. |
Acromion Fracture | Fracture of the lateral scapula, typically due to direct trauma. Causes pain and limited shoulder movement. |
Sprains and Strains | |
AC Ligament Sprain | Injury to the acromioclavicular ligament, common from falls or direct impacts. Severity ranges from mild stretching to complete tears. |
Glenohumeral Ligament Sprain | Injury to the ligaments stabilising the shoulder joint, caused by sudden movements or trauma. Results in pain and limited range of motion. |
Tendon Injuries | |
Rotator Cuff Tendinitis | Inflammation of the rotator cuff tendons, caused by repetitive motions or overuse. Results in shoulder pain and weakness. |
Rotator Cuff Tear | Partial or complete tear resulting from acute injury or chronic wear. Causes pain, weakness, and difficulty raising the arm. |
Nerve Injuries | |
Axillary Nerve Injury | Often due to proximal humerus fractures or shoulder dislocations. Causes weakness in the deltoid muscle and loss of sensation over the lateral shoulder. |
Suprascapular Nerve Injury | Can occur due to trauma or prolonged pressure. Leads to weakness in rotator cuff muscles and shoulder pain. |
Dislocations | |
Glenohumeral Dislocation | Displacement of the humeral head from the glenoid cavity due to direct trauma or falls. Can be anterior or posterior. Causes intense pain, deformity, and loss of mobility. Requires reduction. |
Management Protocol
Initial Evaluation: Perform a quick assessment to identify injury severity. Look for open fractures, visible deformities, and signs of vascular or neurological compromise. Evaluate range of motion and pain.
Diagnostic Imaging: X-rays to confirm fractures and assess bone alignment. CT scans or MRIs may be required for complex injuries or suspected rotator cuff damage.
Initial Treatment: Includes immobilisation with a splint or sling, pain management with analgesics, and elevating the arm to reduce swelling. Dislocations require reduction.
Surgical Intervention: Necessary for displaced fractures, open fractures, severe AC ligament tears, or complete rotator cuff tears. Surgery may be required to repair and stabilise the injury.
Follow-up and Rehabilitation: Physiotherapy is crucial to restore shoulder function and strength. Regular follow-up is necessary to ensure proper recovery and prevent long-term stiffness or weakness.
Each shoulder injury requires a specific approach to ensure optimal recovery and restore full arm functionality.
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