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Anterior Dislocation
• Three major complications:
• Hill-Sachs fracture• Bankart fracture• Greater tubercle
fracture
Luxatio Erecta
• A subtype of Anterior Dislocation with a higher incidence of neurovascular injury.
• Dramatic presentation: Arm is raised over head and locked!
Proximal Humerus Fractures
• Most common locations are surgical neck, anatomic neck, greater and lesser tubercles
Proximal Humerus Fractures
• Usually, elderly patient with osteoporosis, ground level fall.
• 80% can be treated with simple immobilization.
• The rest need closed or open reduction or joint replacement.
Acromio-clavicular Joint Injuries: The players
• Acromio-clavicular ligament
• Ac joint capsule• Coraco-clavicular
ligament
Allman Classification
• Grade I or sprain: occult radiologically
• Grade II or subluxation
• Grade III or dislocation
Allman Grade II
• Wide ac joint: over 7mm.
• Partial elevation of clavicle tip
• Normal cc ligament: less than 13mm
Clavicle Fractures Group II
• 15%. Guarded prognosis; initially treated conservatively but may need delayed surgery
• Neer Type I: Intact cc ligament
• Neer Type II: Torn cc ligament
Scapula Fractures: Body & Glenoid
• Fractures of the body and glenoid can be easy or difficult to see
• CT commonly used to completely evaluate fractures
• Surgical management fairly common
Things that hurt that aren’t acute trauma
• Rotator cuff disease (impingement syndrome)• Calcific bursitis• CPPD disease• Osteoarthritis• Inflammatory arthritis• Septic arthritis/osteomyelitis• Malignancy• AVN
Rotator Cuff Disease
• AKA Impingement Syndrome
• Decades in the making: We only see it at Phase III when cuff is essentially gone
Osteoarthritis
• Primary is not common
• Usually, secondary to – Rotator cuff disease
– CPPD disease
Inflammatory Arthritis
• Rheumatoid arthritis and related entities
• Osteoporosis from hyperemia, erosions, joint destruction and little repair
Infection
• Infection of joint or bone or both
• Any destructive process that crosses a joint is most likely infection