ON THE FIELD MANAGEMENT OF SHOULDER

INJURIES

Jeff Allen

Director of Sports Medicine

University of Alabama

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

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

IS THERE A LIFE-THREATENING INJURY???

Airway

Breathing

Circulation

Disability LOC

ALERT VERBAL PAIN UNRESPONSIVE

IS THERE A LIMB-THREATENING INJURY?

Vascular compromise

Open fracture

Overlying skin integrity

Neurological compromise

MANAGEMENT OF LIFE/LIMB THREATENING INJURIES

Short-term-Deal with ABCD’s

Medium-term-Manage injury/plan to transport

Long-term-Management plan-Notification

LIFE/LIMB THREATENING INJURIES TO SHOULDER

Fractures Clavicle Scapula Humerus

DislocationsGHSC

C-Spine????

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

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

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

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

DISLOCATIONS OF THE SHOULDER

Mechanisms Direct blow Fall on Outstretched Arm MDI

Signs and Symptoms Deformity Loss of motion

Neurovascular Status!!

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.

SECONDARY ISSUES WITH FRACTURES/DISLOCATIONS Pneumothorax

Hemothorax

Tracheobronchial injury

Neurovascular Injuries

NEUROVASCULAR STATUS!!!

PMSCPULSEMOTORSENSORYCAPILLARY REFILL

NON-LIFE THREATENING INJURIES TO THE SHOULDER

YOU CAN RELAX NOW!AC SPRAIN

SC SPRAIN

BPSI/NERVE INJURY

PEC RUPTURE

TRANSPORTATION OPTIONS

RETURN TO PLAY CRITERIA ROM

STRENGTH

FUNCTIONAL ABILITY

CONCLUSION

Don’t complicate the obvious

“Boy Scout” Philosophy

Understand potential life/limb threatening injuries

Always remember to check neurovascular status!