Download Shoulder Fractures By Ahmad A. Abu Tair & Khattab M. Qatu


The part of the body where the humerus
attaches to the scapula.

The shoulder must be mobile enough for the
wide range actions of the arms and hands,
but also stable enough to allow actions such
as lifting, pushing and pulling.

It is made up of three bones.
Clavicle,
 Scapula
 Humerus.

 Joints
of the shoulder:
1. Glenohumeral
joint (main one, ball and socket joint, articulation between the glenoid
fossa of the scapula (shoulder blade) and the head of the humerus
2. Acromioclavicular joint (articulation between the acromion process of the scapula
and the lateral end of the clavicle )
3. Sternoclavicular joint
manubrium sterni

(articulation between sternal end of the clavicle, and the
There are two kinds of cartilage in the joint:
1. Articular cartilage : covers humerus head and glenoid surface.
It’s a white cartilage which allows the bones to glide and move
on each other. When this type of cartilage starts to wear out (a
process called arthritis), the joint becomes painful and stiff.
2. Labrum : its a ring of rigid fibrous cartilage surrounding the
glenoid cavity, it stabilizes the ball and socket joint!
It is the most mobile joint in the human body.
The muscles and joints of the shoulder allow it to
move through a remarkable range of motion,
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Arm abduction
Arm adduction
Arm flexion(90°)
Arm extention(45°)
Medial rotation of the arm (55°)
Lateral rotation of the arm(40_45°)
Arm circumduction (this is a combination of
the above movement)

The group of four muscles and their tendons
that act to stabilize the shoulder .
*the strength of the joint depend on the tone of
these group of muscle which across in
front,above ,behind the jont
1- Supraspinatous – abducts the arm
2- Infraspinatous – external rotation
3- Teres Minor – external rotation
4- Subscapularis – internal rotation
These muscles arise from the scapula and connect to the
head of the humerus, forming
a cuff at the shoulder joint.
They hold the head of the humerus in the small and
shallow glenoid fossa of the scapula.
Nerve supply:axillary and suprascapular nerve
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
Tendinitis.

Tear.

Frozen Shoulder.

Instability.
Calcific Tendinitis

A disorder characterized by deposits of crytalline
calcium phosphate in any tendon of the rotator
cuff muscles causing inflammation and pain.


It is of unknown etiology.
Most people over the age of 40
Pain is aggravated by elevation of the arm above
shoulder level or by lying on the shoulder.


.
sever Pain may awaken the patient from sleep.
its one of the most painful conditions in the
shoulder
When this condition is symptomatic, it may present in the
following 2 ways:
• Chronic, relatively mild pain with intermittent flares, similar
to shoulder impingement syndrome, is believed to indicate
that the condition is in the formative phase.
• Mechanical symptoms may arise from a large calcific
deposit
pain
→
build up of pressure in the tendon
→limitation of movement
→intense

Diagnoses by :
Xray
 Ultrasound (more accurate)

calcific deposits are visible as lumps or
cloudy areas. Mostly found on the greater
tuberosity
NSAID injection
 Injections, needling, and lavage Breaking
up the calcific deposits by repeatedly
puncturing them with a needle, aspirating
the calcific material, with the help of saline.
 Surgery(rarely required)
 Physiotherapy to regain muscle strength



Also called: swimmer's shoulder or thrower's shoulder
It is a clinical syndrome which occurs when the
tendons of the rotator cuff muscles become irritated
and inflamed as they pass through the subacromial
space, the passage beneath the acromion.

Individuals at highest risk are laborers and those
working in jobs that require repetitive overhead
activity like swimmers and athletes.

Symptoms: pain increase at night, weakness and loss
of movement at the shoulder

increase in shoulder pain with overhead activities
Causes:
The rotator cuff muscle tendons pass through a
narrow space between the acromion process of the
scapula and the head of the humerus. Anything
which causes further narrowing of this space can
result in impingement syndrome. This can be
caused by bony structures such as subacromial
spurs (bony projections from the acromion),
osteoarthritic spurs on the acromioclavicular
joint, and variations in the shape of the acromion.
Thickening or calcification of the
coracoacromial ligament can also cause
impingement. Loss of function of the rotator cuff
muscles, due to injury or loss of strength, may
cause the humerus to move superiorly, resulting in
impingement. Inflammation and subsequent
thickening of the subacromial bursa.
Conservative mostly :
 injectable corticosteroid
 Ice packs
 Cessation of painful activity and rest
 physiotherapy
.

If the patient remains significantly disabled and has
no improvement after 3 months of conservative
treatment,
 consider other etiologies or refer for surgical
evaluation.

Rotator cuff tears are tears of one or more of the
four tendons of the rotator cuff muscles .

Rotator cuff tears are among the most common
conditions affecting the shoulder
The most frequent cause of rotator cuff damage is
age related degeneration and less frequently by
sports injuries or trauma



the supraspinatus muscle is most frequently torn as
it passes below the acromion;
the tear usually occurs at its point of insertion onto
the humeral head at the greater tuberosity
Clincal Features

Age:45-75 year old.

Acute tears: raising arm against resistance, (like in
weight lifting,) or falling forcefully, causes Immediate
pain that radiates through the arm, and limited range of
motion, specifically during abduction motions of the
shoulder .

Drop Arm sign. (The result is positive if the patient is
unable to lower the affected arm slowly and smoothly
from a position of 90 degrees of abduction. The arm
drops immediately to the side.)
Types:
Partial tear: recover gradually
With supraspinatus tendonitis
Complete tear:
Sudden shoulder strainor a complication of
tendonitis
 pain soon subside
 gross weakness of abductor muscles
Treatment:

Conservative
-
NSAID injections
Rest
Physiotherapy
-
Operative
-
- young active individuals with
complete tears.
- contraindicated in elderly
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