shoulder injuries in emergency department This is quick review of important conditions not to be missed and their management It includes uncommon injuries and shoulder dislocations along with their emergency treatment

1. Shoulder Conditions in ED
Muni Pinjala DNB (Orth) FRCS (Tr&Orth)
29/07/2022

2. Young female, fall from bike

3. Sternoclavicular joint subluxation/dislocation
• Trauma
• Infection/Inflammation
• Hyperlax
• Anterior/Posterior
• Serendipty view/CT scan
• Posterior - Urgent reduction!!
• pressure on the trachea or large vessels,
• venous congestion of the neck and arm
• circulation to the arm may be decreased

4. Young male , Motorcycle accident
• Cervical spine
• Brachial plexus
• Scapular
• Rib fractures
• Pneumothorax

5. Brachial Plexus injuries
• Pain and weakness of limb
• Horners syndrome
• Scapular winging
• Neck bruising
• Auscultate chest
• Check pulses
• Neurology

6. 25yr old with 4wks h/o pain and worsening
weakness rt shoulder. No trauma. Pins and
needles in hands.
• Wasting of deltoid,
supra/infraspinatous
muscles
• Scapular winging

7. Brachial neuritis/Parsonage Turner syndrome
• Idiopathic
• Viral infection (25% cases),
family history in some
• Inflammation of brachial plexus
and symptoms
• Slow recovery over several
months

8. Mum brought this child with lump and some pain
for few months
Pseudoarthrosis of clavicle

9. Young male, regular weight lifting, shoulder pain
for few weeks
• ACJ
examination
Ostelysis of distal clavicle

10. ACJ arthritis

11. Young patinet with painful shoulder post
motorbike accident, unable to abduct right arm

13. Posterior dislocation
• Uncommon and very easily
missed
• 80% approx- reverse hill sach
• AP- light bulb sign
• Arm adducted and IR
• Always get axillary or modified
axillary if posssible
• Low threshold for CT

15. Inferior dislocation (Luxatio erecta)
NV injury high
risk 40-60%
Very rare

17. 50y M, coming with longstanding pain Lt shoulder
now seems to have worsened after trying to do
DIY
• No trauma
• Normal neurolgy
• Full passive shouler ROM
• Active movements painful and
restricted
Shoulder xray looks normal
Impingement and Cuff exam

18. Neer impingement sign
Drop arm test
Belly press test
Empty can test
Lag tests

19. 20M presents with shoulder pain, feeling of clicks
and weakness. Feels shoulder goes out and comes
back in. Xray is normal.
• Increased ER
• Sulcus test +
• Anterior instability test
• Posterior instability test
• Ligamentous laxicity
Multidirectional Instability of Shoulder

20. 62F, worsening shoulder pain with stiffness. No
trauma. Diabetic, IHD and hypercholesterol
• Reduced Passive and active ROM
• Zero external rotation
• Normal neulogy and Pulses
• Frozen shoulder
• DM, Thyroid, Heart, Cervical
spine
• self limiting
• Normal Xray

21. Young male fell on outstreched hand (bike)
shoulder pain
• Glenoid Fracture
• C-spine
• Chest
• Brachial plexus
• UL pulses
• CT scan

23. Proximal Humerus fractures

24. Sudden pop with bruising and pain felt during
bench press
Pectoralis Major Rupture

25. Painful shoulder with worsening +
collapse/sclerosis of Humeral head
Post trauma
Alcohol,AIDS
Steroids
Idiopathic/
Infection
Avascular necrosis of shoulder

26. 35F presenting with worst shoulder pain in her life
after minor blunt injury
• Calcific tendinitis

27. Hook test
Speed test
Yergason test
Biceps tendon rupture

28. Os Acromiale
• Incidental
• painful in some
• Impingement symptoms
• looks like acromion fracture in
axillary view

29. Synovial chondromatosis
Pain worse with activity
30-50 yrs
Multiple loose bodies
Benign synovial condition

30. Sarcoma- Pain, swelling, rapid increase,
fracture,Wt loss, loss of appetite, warm,tender,
veins

31. • Osteosarcoma can mimic Healing fracture and Ostemyelitis on xrays
• Clinical history is very important

32. Thank you