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Acute Injuries: Shoulder Fractures and Acromioclavicular and Sternoclavicular Joint Injuries

Key Points

The most common cause of a proximal humerus fracture is a fall on outstretched hands from a standing position. Another mechanism of injury is excessive rotation while the arm is abducted. Although fracture of the proximal humerus significantly limits function of the upper extremity, careful neurovas cular examination of the entire upper extremity […]

Management-Operative Management

For axillary nerve injury resulting from penetrating trauma or iatrogenic causes, management is immediate repair. When axillary nerve injury results from causes other than penetrating trauma or surgery (i.e., those with closed trauma), surgery is indicated for symptomatic patients with no clinical or EMG/NCV evidence of recovery 3 to 6 months following injury.

The best […]

Evaluation-Physical Examination

The physical examination of athletes with axillary nerve injury should include evaluation for range of motion (passive and active) as well as strength (abduction, forward elevation, external rotation, and internal rotation). Patients with a chronic history of the problem may demonstrate atrophy or asymmetry of the deltoid muscle mass.

A neurovascular examination should be performed […]

Biomechanics

The most common mechanism of injury to the axillary nerve is closed trauma involving a traction injury to the shoulder,such as stretching of the nerve over the humeral head during an anterior shoulder dislocation. The incidence of axillary nerve injury has been reported to be between 19% and 55% following an anterior shoulder dislocation and […]

Axillary Nerve Injury

Axillary nerve injuries generally are uncommon in sports and have been estimated to represent less than 1% of all nerve injuries. Most of the problems are associated with a trauma, such as an anterior shoulder dislocation or a combined brachial plexus injury.

Postoperative complications also have been reported. Another uncommon syndrome involves compression of the […]

Evaluation-imaging

Imaging techniques to help in the evaluation of suprascapular nerve injury include the standard radiographic shoulder series, including an AP radiograph in which the beam is directed caudally by 15 to 30 degrees. The suprascapular notch also may be seen on the Stryker notch view.

Although plain radiographs usually are nondiagnositic, they can be useful […]

Evaluation-Physical Examination

The physical examination findings of the athlete depend on the degree of nerve dysfunction and the chronicity of the injury. Athletes presenting early in the process often have an examination that is nonfocal and nonspecific. Patients with chronic problems will demonstrate wasting or atrophy of the involved muscles.

If the nerve is injured or entrapped […]

Suprascapular Nerve Injury

A subtle cause of shoulder pain and weakness involves compression or traction of the suprascapular nerve. Overhead and throwing athletes often are affected because of repetitive trauma (e.g., tennis players, baseball players, and weight lifters). Volleyball players are particularly affected, with one series reporting up to 45% of athletes having clinical and neurophysiological evidence of […]

Other Diagnostic Tools

Blood work, such as a complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein, and blood cultures, may be useful to confirm and to follow spinal infections. A rheumatological workup may be ordered if seronegative spondyloarthropathy, such as ankylosing spondylitis, is suspected.

The use of electrophysiological testing can confirm a clinical diagnosis, such as […]

Entrapment of the Ulnar Nerve (Ulnar Neuritis)

If the medial posterior aspect of the elbow is accidentally hit, pain can be felt radiating to the fourth and fifth fingers of the hand. The ulnar nerve runs along the medial edge of the elbow just behind the epicondyle to which the flexor muscles of the wrist are attached. In throwing or racket sports […]