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Chapter 13 – The Shoulder and Upper Arm

Chapter 13 – The Shoulder and Upper Arm. Pages 484 - 488. Question #1 . What are the most important pathologies to rule out? Why?. On-Field Evaluation of Shoulder Injuries. Most important to rule out Fractures Dislocations Distal Pulse Evaluation of cervical and/or thoracic spine.

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Chapter 13 – The Shoulder and Upper Arm

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  1. Chapter 13 – The Shoulder and Upper Arm Pages 484 - 488

  2. Question #1 • What are the most important pathologies to rule out? • Why?

  3. On-Field Evaluation of Shoulder Injuries • Most important to rule out • Fractures • Dislocations • Distal Pulse • Evaluation of cervical and/or thoracic spine

  4. Question #2 • Describe equipment considerations when evaluating a shoulder on the field.

  5. Equipment Considerations • Familiarize yourself! • Palpation Under the Shoulder Pads • Figure 13-36 , page 485 • Removal of the Shoulder Pads • Figure 13-37,page 486

  6. On-Field History • Location of Pain • Shoulder vs. brachial plexus pathology • Mechanism of Injury

  7. Question #3 • Describe an on-field inspection of the shoulder.

  8. On-Field Inspection • Arm Posture • Arm splinted against the torso • Clavicular fracture, AC joint pathology • Arm hanging limply • Brachial plexus pathology • Arm “locked” • GH dislocation • Gross Deformity

  9. Question #4 • Describe on-field palpation of the shoulder.

  10. On-Field Palpation • Position of humeral head • AC joint alignment • Piano key sign • Clavicle • SC joint • Humerus

  11. Question #5 • Describe on-field functional tests for the shoulder.

  12. On-Field Functional Tests • Rule out dislocation or fracture • Apley’s Scratch test

  13. Initial Management of On-Field Shoulder Injuries • Figure 13-38, page 487

  14. Question #6 • Describe scapular fractures.

  15. Scapular Fractures • Body of scapula, glenoid fossa, glenoid neck, coracoid process • Secondary to GH dislocation • S/S similar to rotator cuff pathology • Immobilization/transportation

  16. Clavicular Injuries • Clavicular Fractures • Immobilization, referral to physician • SC Joint Injuries • Potential compromise to underlying structures from posterior dislocation • Immobilization, transportation (supine)

  17. Clavicular Injuries • AC Joint Injuries • Figure 13-39, page 488 • Nonsurgical treatment • Protection during activity

  18. Question #7 • Describe GH dislocations.

  19. GH Dislocations • Monitor distal pulses, circulation, sensation • Immobilization • Keep wrist and hand exposed • Immediate transportation • Reductions performed by physician

  20. Question #8 • Describe humeral fractures.

  21. Humeral Fractures • Extreme pain, dysfunction, obvious deformity • May be secondary to GH dislocation • Immobilization • Keep wrist and hand exposed • Immediate referral to physician

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