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Fractures of the Humerus, Clavicle, and Scapula

What is a fracture?

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

  • high-energy trauma

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

  • Sharp Pain

  • Percussion Test

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:

  • tapping the acromion

Positive Sign

  • Pain

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

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