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ON THE FIELD MANAGEMENT OF SHOULDER
INJURIES
Jeff Allen
Director of Sports Medicine
University of Alabama
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SHOULDER STATISTICS Football
13% of all reported time loss injuries3rd highest (knee, ankle)Avg. time loss of 7 days
High School Survey10% of all time loss injuries (2005-2010)
Datalys Center, NCAA Injury Surveillance Program
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OBJECTIVES IN ON THE FIELD MANAGEMENT OF INJURIES
Rule out/manage life or limb threatening injuries
Determine the extent of the injury
Determine Transportation Options/Method
Make a Return to Play Decision
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IS THERE A LIFE-THREATENING INJURY???
Airway
Breathing
Circulation
Disability LOC
ALERT VERBAL PAIN UNRESPONSIVE
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IS THERE A LIMB-THREATENING INJURY?
Vascular compromise
Open fracture
Overlying skin integrity
Neurological compromise
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MANAGEMENT OF LIFE/LIMB THREATENING INJURIES
Short-term-Deal with ABCD’s
Medium-term-Manage injury/plan to transport
Long-term-Management plan-Notification
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LIFE/LIMB THREATENING INJURIES TO SHOULDER
Fractures Clavicle Scapula Humerus
DislocationsGHSC
C-Spine????
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FRACTURES Damage to the bone is
the secondary concern
Primary concern is the damage the bone does to the surrounding structures
Evaluate Neurovascular Function Distally
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CLAVICLE FRACTURE Mechanism
Fall on Outstretched Hand
Signs and Symptoms Sudden pain Tenderness Loss of shoulder
function Deformity(rapid
swelling/bony deviation)
Head tilt towards side of fracture
Crepitus
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SCAPULA FRACTURE Mechanism
Direct trauma Indirect trauma from fall
(on shoulder or arm) Infrequent
Signs and Symptoms Sudden pain
Painful abduction
Loss of function Tenderness
(direct/indirect) Possible crepitus
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HUMERUS FRACTURE Mechanism
Direct trauma Fall on an outstretched
arm
Signs and Symptoms Sudden pain Loss of function Tenderness Deformity Rapid Swelling
Proximal or Shaft
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DISLOCATIONS OF THE SHOULDER
Mechanisms Direct blow Fall on Outstretched Arm MDI
Signs and Symptoms Deformity Loss of motion
Neurovascular Status!!
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POSTERIOR SC DISLOCATION
Mechanism Anterior dislocations of the SCJ are much more
common (by a 9:1 ratio) Direct blow Fall on Outstretched Arm
Signs and Symptoms Pain and Deformity Altered Neurovascular Status
Complications may include: Pneumothorax Laceration of the superior vena cava Occlusion of the subclavian artery or vein Disruption of the trachea.
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SECONDARY ISSUES WITH FRACTURES/DISLOCATIONS Pneumothorax
Hemothorax
Tracheobronchial injury
Neurovascular Injuries
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NEUROVASCULAR STATUS!!!
PMSCPULSEMOTORSENSORYCAPILLARY REFILL
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NON-LIFE THREATENING INJURIES TO THE SHOULDER
YOU CAN RELAX NOW!AC SPRAIN
SC SPRAIN
BPSI/NERVE INJURY
PEC RUPTURE
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TRANSPORTATION OPTIONS
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RETURN TO PLAY CRITERIA ROM
STRENGTH
FUNCTIONAL ABILITY
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CONCLUSION
Don’t complicate the obvious
“Boy Scout” Philosophy
Understand potential life/limb threatening injuries
Always remember to check neurovascular status!