Saturday AM Sports/Orthopedic Clinic

Presentation

• Left Shoulder pain

• Name some reasons for shoulder pain?

Causes of shoulder pain

• Suprascapular nerve entrapement• Shoulder instability• Thoracic outlet syndrome• Cervical radiculitis• Bicipital tendonitis• rotator cuff disease

Name all of the joints involved in the shoulder girdle complex?

7 Joints in Shoulder Girdle Complex

• GH Joint• Suprahumeral joint• AC Joint• Scapulocostal jt• Sternoclavicular joint• Sternocostal jt• Costovertebral joint

Unstable joint?

• What structures causes the shoulder (glenohumeral) joint to be highly mobile but relatively stable

• The relatively poor bony congruence between the gleniod and humeral head and a slack capsule

• What structure provides the strongest support for the AC joint?

• The coracoclavicular ligament which descends from the distal clavicle to the coracoid process. The ligament must be torn to produce the major stepdown of the acromion below the clavicle in grade 3 acromioclavicular joint injuries

• What other causes of shoulder pain?

Can the pain be referred?

What else?

• Pale• Clammy• Pain in epigastrum

Positive Kehr’s Sign

What is it?

Left shoulder pain

• Free intraperitoneal blood

• Diaphragmatic irritation

Kehr’s Sign, neglected aid in rupture of the spleen

New England Journal of Medicine

Name some other symptoms of spleen injury?

Splenic Injury

• Generalize abdominal pain• Left shoulder pain• Aggravated by deep pressure of left

hypochondrium• Tenderness to rectal palpation• Slight increase in temperature• FAST test

What is the most commonly injured viscous in blunt trauma?

Spleen the most commonly injured viscous in blunt

abdominal trauma

Delayed rupture presenting as unstable angina pectoralis

What causes a delayed rupture spleen?

Causes of the delayed bleed?

• Tamponade (old blood clots)

• Subscapular hemorrhage

• Small tamponade forms clot on omentum or bowel laceration

• Subscapular hemorrhage may be present for several days before rupture of the capsule takes place

How long can the delayed rupture occur?

Delayed

• Less than an hour and Up to 14 days• Several months• 21% delayed

Journal of Trauma 2008

• 673 non operative spleen• Mild – 12.5 heal• Severe – 37 days• 20% not heal after 3 months• 10% worse as outpatient

What is the mortality?

• Mortality of a simple spleen rupture is 1%

When would allow the player to return to sports?

Full return not until 6 months