0071643192.pdf

ORTHOPEDICS

ROTATORCUFFINJURIES

Continuum of injury: Mechanical impingement →rotator cuff tendonitis →

rotator cuff tear.

MECHANISM

Impingement of subacromial space by humeral head due to repeated eleva-

tion of arms above shoulders

DIAGNOSIS

■ Shoulder pain (initially only with activity) and eventual loss of motion

■ All have pain between 60° to 120° of shoulder abduction (painful arc).

■ Rotator cuff tendonitis:Preserved strength of rotator cuff SITSmuscles

(supraspinatus, infraspinatus, teres minor, subscapularis) especially after

lidocaine injection

■ Rotator cuff tear:Most are acute injuries to a tendon weakened from

chronic impingement. Weakness of SITS muscles. Positive drop arm

test, which is the inability to hold the arm in 90° abduction. MRI can be

diagnostic.

TREATMENT

Physical therapy, steroid injection, surgery if rotator cuff tear

ACROMIOCLAVICULAR(AC) SEPARATION

AC separation usually results from a fall with a direct blow downward on the

outer shoulder (snowboarders, football players).

DIAGNOSIS

The diagnosis can usually be made clinically by reproducing the pain with

palpation of the AC joint.

TREATMENT

Depends on the degree of separation (see Table 4.2)

FIGURE 4.12. Inferior shoulder dislocation (luxatio erecta).

Most commonelbow

dislocation=posterior

dislocation.

Most common shoulder

dislocation=anterior

dislocation.

Most common types

of dislocations—

PEAS

Posterior for

Elbow

Anterior for

Shoulder