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Saturday AM Sports/Orthopedic Clinic. Presentation. Left Shoulder pain. Name some reasons for shoulder pain ?. Causes of shoulder pain. Suprascapular nerve entrapement Shoulder instability Thoracic outlet syndrome Cervical radiculitis Bicipital tendonitis r otator cuff disease.
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Presentation • Left Shoulder pain
Causes of shoulder pain • Suprascapularnerve entrapement • Shoulder instability • Thoracic outlet syndrome • Cervical radiculitis • Bicipitaltendonitis • rotator cuff disease
Name all of the joints involved in the shoulder girdle complex?
7 Joints in Shoulder Girdle Complex • GH Joint • Suprahumeraljoint • AC Joint • Scapulocostaljt • Sternoclavicular joint • Sternocostaljt • Costovertebral joint
Unstable joint? • What structures causes the shoulder (glenohumeral) joint to be highly mobile but relatively stable
The relatively poor bony congruence between the gleniodand humeral head and a slack capsule
What structure provides the strongest support for the AC joint?
The coracoclavicular ligament which descends from the distal clavicle to the coracoid process. The ligament must be torn to produce the major stepdown of the acromion below the clavicle in grade 3 acromioclavicular joint injuries
Pale • Clammy • Pain in epigastrum
Positive Kehr’sSign What is it?
Left shoulder pain • Free intraperitoneal blood • Diaphragmatic irritation
Kehr’s Sign, neglected aid in rupture of the spleen New England Journal of Medicine
Splenic Injury • Generalize abdominal pain • Left shoulder pain • Aggravated by deep pressure of left hypochondrium • Tenderness to rectal palpation • Slight increase in temperature • FAST test
Spleen the most commonly injured viscous in blunt abdominal trauma
Causes of the delayed bleed? • Tamponade (old blood clots) • Subscapular hemorrhage • Small tamponade forms clot on omentum or bowel laceration • Subscapular hemorrhage may be present for several days before rupture of the capsule takes place
Delayed • Less than an hour and Up to 14 days • Several months • 21% delayed
Journal of Trauma 2008 • 673 non operative spleen • Mild – 12.5 heal • Severe – 37 days • 20% not heal after 3 months • 10% worse as outpatient