Fractures of the Humerus, Clavicle, and Scapula
A fracture is an injury to the bone the tissue of the bone is broken.
Bones
- clavicle- only connection of the shoulder girdle
- scapula-serves as anchor for supraspinatus, infrasinspinatus, teres minor, and subscapularis(SITS)
- humerus- serves as an insertion for the infrasspinatus and the teres minor
Different shoulder injuries vary on age.
- In children , clavicle injuries are more more common
Especially during birth
- In adults, proximal humerus are more common
- Fracture may occur during dislocation
Etiology
Humerus
- A direct hit to the shoulder
- Falling on outstretched arm with a locked elbow
The most common injury is to the shaft and to the proximal part of the humerus.
Clavicle
- Falling with arm out onto hand
- Falling on the the shoulder
- A direct hit to the shoulder
Scapula
Motor Vehicle Accident
- Falling onto back from heights
Common Sports
- Football
- Hockey
- Soccer
- Wrestling
Signs and Symptoms
HUMERUS
- Swelling
- Bruising
- Pain or tenderness
- Stiff
- Crepitus may occur-grinding
- Numbness may occur in hand because of radial nerve damage which travels from the spine, wraps around the humerus, and travels down the hand
CLAVICLE
- Deformity
- Grinding
- Tenderness
SCAPULA
- A pop or snapping
- Limited range of motion(ROM)
- Abrasion-scraping of the skin
Key Sign and Symptoms
HUMERUS
- Feeling of instability in the distal area of the humerus
"elbow wants to pop"
- Server bruising of bicep
- Bone sticking out of the skin(rare)
CLAVICLE
- The shouder may sag.
- Swelling
- Bruising
After swelling has gone down the fracture is often easily felt through the skin.
SCAPULA
- Loss of feeling in the arm
- Weakness
- Swelling and bruising within 30 minutes of the injury
- Pain increase in arm movement or when pressure is added.
Special Tests
Palpation
- Long Bone Compression Test
- The examinee is relaxed while the examiner is applies a compressed force on the bone.
Positive Pain
This test where exaimer taps to sends forces through the bone.
If posibility of a humeral fracture:
- tapping the radius or the acromion
If possibility of a clavicular fractures:
Positive Sign
Diagnostic
- CT scan( 3D xrays) and a X-Ray( 2D form of electronmagnetic radiation) are used to get a picture of what the bone looks when injuried.
Treatment
Nonoperative
- For the humeral, clavicular, and scapular fracture, the victim will be placed in a figure 8 sling or a shouler immobilizer and then referred to the emergency room, doctors, or to an orthopedics.
Operative
- Plates, screws, and wires are place during surgery.
HUMERUS
- It the fracture is the proximal humerus, then the shoulder might have to be replaced.
CLAVICLE
- Rods are placed into the clavicle
SCAPULA
- Surgery is highly recommanded.
Surgery is more needed when the glenoid is diplaced of the loint surface, the acromion, or neck of the scpaula.
Bibliograghy
- http://emedicine.medscape.com/article/1263076-treatment#a1128
- http://www.niams.nih.gov/Health_Info/Shoulder_Problems/default.asp
- http://www.springerlink.com/content/q3q7343238203810/
- http://orthoinfo.aaos.org/topic.cfm?topic=A00072
- http://orthoinfo.aaos.org/topic.cfm?topic=A00513
- http://www.wheelessonline.com/ortho/humeral_shaft_fractures_in_children
- http://northspokanept.com/Injuries-Conditions/Shoulder/Shoulder-Issues/Adult-Shoulder-Fractures/a~3803/article.html
- http://web.jbjs.org.uk/cgi/reprint/70-B/3/461.pdf
- http://web.jbjs.org.uk/cgi/reprint/70-B/3/461.pdf
- http://www.youtube.com/watch?v=lCEXnvh08p0
Shoulder Joint Cont.
By: Patricia Lott
Sport Medicine III
7th
Shoulder Joint