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Acromioclavicular (AC) joint dislocation Anterior shoulder dislocation– most common • Mechanism = direct blow to the top of the 95% shoulder, inyoung contact sport athletes • Mechanism = occurs in young patients • Presentation = tender prominence over the AC following contact sports, orinelderly joint. patients following a FOOSH • Test = scarftest (cross arm adduction test) +ve • Presentation = arm is forced into abduction, extension and external rotation. will elicit pain over the AC joint. • Management = X-ray imaging to look for Loss of shoulder contour and anterior bulge displacement of the underside of the acromion from the humeral head in the axilla. and the distal clavicle. • Management = check pulses and nerves, including axillary nerve, pre andpost Gradedusing the Rockwood classification. 1-3 can be treated conservatively using a sling reduction. Obtain pre/ post reduction Xray 4-6 require orthopaedic involvement, treated Simple reduction supports the arm in surgically. internal rotationwithbroadarm s ling and fracture clinic follow up. by Gregor ramage and Dr Shaheer Aslam Joiya Posterior dislocation of the shoulder - rare Shoulderinjuries • Mechanism = associated with epileptic Function of the rotator cuff muscles seizures orelectric shocks . § Supraspinatus = abduction (first 20degrees, Impingement syndrome • Presentation = limitationofexternal then deltoid takes over). Suprascapular • Pain on abduction between 45-160 degrees, rotation. Can present asmissed. nerve C5 painful arc or increasinglypainfull until full • Imaging= lightbulbsignonx-ray imaging § Subscapularis = internal rotation (last from anteroposterior view. movement to recover after soft tissue abduction. shouldersurgery). Subscapular nerve C5 -6 • Test = +ve Hawkins test, painful arc made worse • Management= same as above with thumb pointing up. § Infraspinatus= external rotation. Rotator cuff tears Suprascapular nerve C5 • Management = physiotherapy and pain reliefto • Mechanism = can be due to degeneration § Teres Minor = external rotation and start, thencorticosteroidinjections. inthe elderly ortrauma inyounger extension. Axillary nerve C5 Frozen shoulder (adhesive capsulitis) patients. • No obvious trigger can have severe pain that is worse at The Axillary nerve = motor and sensory innervation night, unabletolie ononeside. • Presentation= complain of shoulder to the deltoid including ‘sergeants’ patch’ • Painful phase(6 weeks-9 months)active and passive weakness and night pain, with the patient The long thoracic nervesupplies the serratus movement ¯. Esspecialyexternal rotation unable to keep it in a comfortable position. anterior, Damage results in ‘winging of the scapula’ • Frozen phase(6-12 months)pain settles but shoulder • Management = <50 years need urgent remains stiff. • Thawing phase(1-3 years)– slowly regains range of investigationandtreatment toregain Whenassessing shouldertrauma always assess motion. function. MRI more usefull as provides neurovascular status and pulses of the upper limb. • Treatment = early physiotherapy and NSAIDS, informationabout muscle wasting. LOOK, FEEL, MOVE Complete tear= surgery, incomplete = corticosteroids help short term. • Most common in middleaged females – increase with physio. diabetes.