SHOULDER
Injury MOI Tests/ what hurts TX
Anterior Shoulder Fall on abd/ ext rot Pt presents with arm held in ext rotation Reduction
Dislocation MC arm Hurts to internally rotate r/o axillary nerve injury
Axillary & Y view. Squared off shoulder
Posterior Shoulder Fall on add/ in rot Hurts to externally rotate Reduction
Dislocation (seizure)
Shoulder Separation Direct blow to arm at side, pain with ROM/lifting arm Type I and II: brief sling
“AC joint dislocation” adducted shoulder and on palpation +cross over III/IV : surgery
“bump deformity” Xray with weights
Rot cuff “SITS” Chronic use/trauma active ROM, and pain with internal Tendinitis: shoulder
rotation and abduction (overhead) pendulum exercise, ice, Nsaid
-Tendinitis <40 yo
-Tear > 40 yo Hawkins: flex at 90, int rotate Tear: rehab, NSAID, intra-
Drop Arm: lift arm past 90 articular steroids, surgery
Empty Can: thumbs down
NEER test: pain with fwd flex w. arm up
Adhesive Capsulitis d/t inflammation ROM with ext rotation with gradual Rehab ROM
common in diabetics return of ROM/ pain worse at night Anti inflame, steroid INj, heat
ON PE: resistance with passive ROM
Clavicle fracture High energy impact Pain with ROM mid 1/3: sling 4-6 wks (fig 8)
Common in mid 1/3 of clavicle prox 1/3: ortho
Proximal Humerus FOOSH / direct blow Pt presents with arm adducted Sling early ROM
Fracture Common site for path R/o brachial plex injury (delt sensation)
fx in Breast CA
Humeral Shaft FX Foosh/direct blow R/O radial nerve injury (wrist drop) Sugar tong splint
Coaptation split
Ortho f/u
Thoracic Outlet Synd Idiopathic Nerve Comp: pain/parathesias on ulnar Physical therapy, ortho
compression of : Vasc comp: swell/ discolor w/ abduction consult, surgery
Brachial plex, subclav PE: +Adson loss of radial pulse (hd twd)
vein/artery
MRI for dx
1
, ELBOW / FOREARM
Injury MOI Tests/ what hurts TX
Supracondylar FX Fall on hyperextended elb Swelling/tend of elbow, olecranon depress Nondisp: splint (posterior)
Abnormal Ant humeral line Displaced: ORIF
*mc elbow inj in kids Anterior fat pad seen in kids
*complications:
1. Medial/brachial artery injury
volkmanns contracture: claw!
2. Malunion
3. nerve injury: Anterior interosseus, or radi
Radial head Foosh ext elbow Lateral/radial head pain , cant extend elbow Long arm splint at 90
fracture Posterior fatpad KIDS
Anterior sail sign: ADULTS
Olecranon fx Fall on flex elbow Cant extend elbow Non displaced: splint 90
May cause the tricep to rupture Displaced: ORIF
Ulnar nerve injury
Olecranon bursitis Inflammation of bursa Abrupt goose egg , boggy red elbow Rest nsaids, steroid inj, avoid
Gout, trauma, infection Limited ROM with flexion repetitive mvmtns
Elbow dislocation Mc posterior Child presents with flex arm and prominent EMERGENT REDUCTION
Foosh with hypertext elb elbow, cant extend POSTERIOR SPLINT
EMERGENCY *must r/o brach artery, med/rad/uln injury
Ulnar shaft fx Direct blow Localized pain / swelling Distal 1/3: short arm cast
“night stick” Prox 1/3 : long Displaced: orif
Monteggia : Direct blow: Prox ulnar Elbow pain . Radial nerve injury: wrist drop Orif
fx, Radial dislocation
Galeazzi Distal Rad fx, ulnar Will look deformed – UNSTABLE Unstable: needs orif
dislocation Long arm/ sugar tong
Radial head Swinging a pronated/ Child will present with arm flexed refusing Reduction: supinate / flex
Subluxation extended arm to use arm. Tenderness to radial head
Lateral Repetitive pronation of Lateral elbow pain, RICE, nsaid, brace
Epicondylitis arm and wrist extension pain with forearm pronation and extension
of wrist against resistance
Tennis Inflam of ECRB
Medial Epicond Inflame of PTFC Pain with forearm supination and wrist RICE, nsaid, brace
Golf flexion against resistance
2
Injury MOI Tests/ what hurts TX
Anterior Shoulder Fall on abd/ ext rot Pt presents with arm held in ext rotation Reduction
Dislocation MC arm Hurts to internally rotate r/o axillary nerve injury
Axillary & Y view. Squared off shoulder
Posterior Shoulder Fall on add/ in rot Hurts to externally rotate Reduction
Dislocation (seizure)
Shoulder Separation Direct blow to arm at side, pain with ROM/lifting arm Type I and II: brief sling
“AC joint dislocation” adducted shoulder and on palpation +cross over III/IV : surgery
“bump deformity” Xray with weights
Rot cuff “SITS” Chronic use/trauma active ROM, and pain with internal Tendinitis: shoulder
rotation and abduction (overhead) pendulum exercise, ice, Nsaid
-Tendinitis <40 yo
-Tear > 40 yo Hawkins: flex at 90, int rotate Tear: rehab, NSAID, intra-
Drop Arm: lift arm past 90 articular steroids, surgery
Empty Can: thumbs down
NEER test: pain with fwd flex w. arm up
Adhesive Capsulitis d/t inflammation ROM with ext rotation with gradual Rehab ROM
common in diabetics return of ROM/ pain worse at night Anti inflame, steroid INj, heat
ON PE: resistance with passive ROM
Clavicle fracture High energy impact Pain with ROM mid 1/3: sling 4-6 wks (fig 8)
Common in mid 1/3 of clavicle prox 1/3: ortho
Proximal Humerus FOOSH / direct blow Pt presents with arm adducted Sling early ROM
Fracture Common site for path R/o brachial plex injury (delt sensation)
fx in Breast CA
Humeral Shaft FX Foosh/direct blow R/O radial nerve injury (wrist drop) Sugar tong splint
Coaptation split
Ortho f/u
Thoracic Outlet Synd Idiopathic Nerve Comp: pain/parathesias on ulnar Physical therapy, ortho
compression of : Vasc comp: swell/ discolor w/ abduction consult, surgery
Brachial plex, subclav PE: +Adson loss of radial pulse (hd twd)
vein/artery
MRI for dx
1
, ELBOW / FOREARM
Injury MOI Tests/ what hurts TX
Supracondylar FX Fall on hyperextended elb Swelling/tend of elbow, olecranon depress Nondisp: splint (posterior)
Abnormal Ant humeral line Displaced: ORIF
*mc elbow inj in kids Anterior fat pad seen in kids
*complications:
1. Medial/brachial artery injury
volkmanns contracture: claw!
2. Malunion
3. nerve injury: Anterior interosseus, or radi
Radial head Foosh ext elbow Lateral/radial head pain , cant extend elbow Long arm splint at 90
fracture Posterior fatpad KIDS
Anterior sail sign: ADULTS
Olecranon fx Fall on flex elbow Cant extend elbow Non displaced: splint 90
May cause the tricep to rupture Displaced: ORIF
Ulnar nerve injury
Olecranon bursitis Inflammation of bursa Abrupt goose egg , boggy red elbow Rest nsaids, steroid inj, avoid
Gout, trauma, infection Limited ROM with flexion repetitive mvmtns
Elbow dislocation Mc posterior Child presents with flex arm and prominent EMERGENT REDUCTION
Foosh with hypertext elb elbow, cant extend POSTERIOR SPLINT
EMERGENCY *must r/o brach artery, med/rad/uln injury
Ulnar shaft fx Direct blow Localized pain / swelling Distal 1/3: short arm cast
“night stick” Prox 1/3 : long Displaced: orif
Monteggia : Direct blow: Prox ulnar Elbow pain . Radial nerve injury: wrist drop Orif
fx, Radial dislocation
Galeazzi Distal Rad fx, ulnar Will look deformed – UNSTABLE Unstable: needs orif
dislocation Long arm/ sugar tong
Radial head Swinging a pronated/ Child will present with arm flexed refusing Reduction: supinate / flex
Subluxation extended arm to use arm. Tenderness to radial head
Lateral Repetitive pronation of Lateral elbow pain, RICE, nsaid, brace
Epicondylitis arm and wrist extension pain with forearm pronation and extension
of wrist against resistance
Tennis Inflam of ECRB
Medial Epicond Inflame of PTFC Pain with forearm supination and wrist RICE, nsaid, brace
Golf flexion against resistance
2
