1. TRAUMATIC SHOULDER CONDITIONS
John W. Gibbs, DO
Orthopaedic Surgeon
Rochester Regional Health Orthopaedics at Red Creek

2. Traumatic Shoulder Conditions
Fractures
Dislocations
Separations
Tendon Tears
Labral Tears

3. Fractures

4. Fractures
Proximal Humerus
Clavicle
Scapular

5. Proximal Humerus Fractures
Anatomy
Head
Greater Tuberosity
Lesser Tuberosity
Shaft

6. Proximal Humerus Fractures
Comprise 4-5% of all fractures
Comprise 45% of all humerus fractures
High energy vs. Low Energy
More common in Females (2:1 over males)
Osteoporosis

7. Proximal Humerus Fractures
Mechanism
Low Energy (most common)
Fall from a standing height
Outstretched arm
Elderly, osteoporotic
High Energy
MVC
More severe fractures

8. Proximal Humerus Fractures
Treatment
Non-operative
85% of all proximal humerus fxs
Immobilizer / sling
Early mobilization 7-10 days
Operative
Considerations
Displacement / Angulation
Age
Activity level
Bone quality
Associated injury

9. Clavicle Fractures Mechanism Fall onto the shoulder
Most common (87%)
Direct clavicle impact (7%)
Fall onto outstretched hand (8%)

10. Clavicle Fractures Classification Middle third (80%)
Most common
Distal third (15%)
Proximal third (5%)

11. Clavicle Fractures Treatment Majority non-operative Distal third Sling
Beware “Z” configuration
Risk nonunion
Distal third
Medial to CC ligaments

12. Scapula Fractures Relatively uncommon Associated injuries
(<1% of all fractures)
Associated injuries

13. Scapula Fractures
Glenoid
Associated with dislocation
Body
High energy

14. Scapula Fractures Treatment Body Glenoid Most non-operative
Consider operative

15. Dislocations / Separations

16. Dislocations / Separations
Glenohumeral Dislocation
Acromioclavicular Separation

17. Dislocations Glenohumeral Dislocation
Most commonly dislocated major joint
45% of all dislocations
Anterior
Most common
8-9 times greater than posterior
Posterior
2nd most common
Superior / Inferior
rare
Inferior Dislocation: Luxatio Erecta

18. Glenohumeral Dislocations
Treatment
Reduction
Immobilizer
Considerations
Non-operative vs operative management
Age
Activity level
Associated injuries

19. Separations Acromioclavicular Separation Males 10:1 over females
Fall onto point of the shoulder

20. Separations Acromioclavicular Separation Treatment Non-operative
Type I & II
Most Type III
Operative
Some Type III
Type IV, V, VI

21. Acromioclavicular Separations
Classification considerations: AC & CC ligaments

22. Acromioclavicular Separations

23. Tendon Tears

24. Traumatic Tendon Tears
Rotator Cuff
Long head Bicep
Pectoralis major

25. Traumatic Tendon Tears
Rotator Cuff
Supraspinatus
Infraspinatus
Teres Minor
Subscapularis

26. Traumatic Tendon Tears
Rotator Cuff
Functional Loss
High suspicion for tear with shoulder dislocation in older patient

27. Traumatic Tendon Tears
Long head Bicep
Distal migration of bicep muscle belly
vs. proximal migration
Functional deficit
Supination
21% loss
Elbow Flexion
8% loss

28. Traumatic Tendon Tears
Long head Bicep
Treatment options
Non-operative
Operative
Bicep Tenodesis

29. Traumatic Tendon Tears
Pectoralis major

30. Labral Tears

31. Labral Tears
Many ways to tear your labrum

32. Labral Tears
Overlapping signs / symptoms with other shoulder conditions
Achy, dull pain
Possible traumatic history
Hanging by arms (Crossfit, Tough Mudder)
Swinging arms (kettlebell)
Ballistic shoulder activity
Mechanical symptoms
Clicking, popping, catching
Associated neurologic symptoms
Numbness, tingling

33. Labral Tears Treatment Wide spectrum of clinical presentation
Analogous to varied meniscal tear presentation
Non-operative
Older, sedentary patients
Degenerative tears
Tend to get stiff from operative repair
Operative
Younger, active patients

34. Traumatic Shoulder Conditions
Younger patients
Older patients
Tend to regain mobility
Potential laxity / instability issues
Tend to stay stiff
Risk for Adhesive Capsulitis
Consider associated / missed injuries

35. Case Presentation - 1 35 y/o male, chiropractor, body builder
bench press, pain anterior shoulder region, divot in his infraclavicular region
Able to continue bench press and weight lifting
Weakness with incline bench press
Presents to office 6 weeks s/p injury
Diagnostic / Treatment options:

36. Case Presentation - 1 Diagnostic / Treatment options:
Clinical diagnosis
Clavicular head pectoralis major tear
MRI
Clavicular head pectoralis major origin avulsion
Treatment
Non-operative vs. operative
Functional
Cosmetic concerns

37. Case Presentation - 2 62 y/o female, retired nurse, active grandmother
Slipped on the grocery store, pain in shoulder region, unable to elevate arm
Seen at urgent care: no fracture, anterior dislocation
Urgent care unable to reduce shoulder
Shoulder reduced at Unity ED
Presents to office 1 week s/p injury
Diagnostic / Treatment options:

38. Case Presentation - 2 Diagnostic / Treatment options:
Xrays repeated at office: maintained reduction
Active elevation to 45 degrees / Abduction to 20 degrees
Significant weakness with external rotation
MRI: Supraspinatus & Infraspinatus complete tendon tear with retraction
Operative intervention

39. Case Presentation - 3
60 y/o male, orthopaedic surgeon, active, cyclist, golfer
Struck from behind by motor vehicle while riding bicycle
Landed on point of shoulder, dominant arm
Seen at urgent care: AC separation, Type III
Self-diagnosed
Presented to office with literature and requested surgery
Active elevation to 45 degrees / Abduction to 20 degrees
Distal clavicle prominent
Primary form of cardiovascular exercise: cycling
Diagnostic / Treatment options:

40. Case Presentation - 3 Diagnostic / Treatment options:
MRI confirms Type III AC separation
Coraco-clavicular ligaments disrupted
Supraspinatus: low-grade partial thickness tearing
Non-operative vs. operative considerations
Shoulder fatigueability and scapular dysfunction
AC arthritis
Continued deterioration of rotator cuff
Elected for AC repair
Returned to all activities and operating

41. Thank you