Injuries of the shoulder and upper arm
Ashley W. Blom, David Warwick, Michael R. Whitehouse in Apley and Solomon’s System of Orthopaedics and Trauma, 2017
The injury is graded according to the type of ligament injury and the amount of displacement of the joint (Figure 24.6). Type I – This is an acute sprain of the acromiocla-vicular ligaments; the joint is undisplaced.Type II – The acromioclavicular ligaments are torn and the joint is subluxated with slight elevation of the clavicle.Type III – The acromioclavicular and coracoclavicular ligaments are torn and the joint is dislocated; the clavicle is elevated (or the acromion depressed) creating a visible and palpable ‘step’. Other types of displacement are less common, but occasionally the clavicle is displaced posteriorly (type IV), very markedly upwards (type V) or inferiorly beneath the coracoid process (type VI).
The Shoulder
Louis Solomon, David Warwick, Selvadurai Nayagam in Apley and Solomon's Concise System of Orthopaedics and Trauma, 2014
If the patient has a useful range of movement, adequate strength and well-controlled pain, nonoperative measures are adequate. If symptoms do not subside after 3 months of conservative treatment, or if they recur persistently after each period of treatment, an operation is considered preferable to prolonged and repeated treatment with anti-inflammatory drugs and local corticosteroids. The indication is more pressing if there are signs of a partial rotator cuff tear and in particular if there is good clinical evidence of a full thickness tear in a younger patient. The object is to decompress the rotator cuff (acromioplasty) by removing the structures pressing upon it – the coracoacromial ligament, the anterior part of the acromion process and osteophytes at the acromioclavicular joint. This can be achieved by open surgery or arthroscopically. If tears are encountered they can be repaired.
Scapular fractures
Charles M Court-Brown, Margaret M McQueen, Marc F Swiontkowski, David Ring, Susan M Friedman, Andrew D Duckworth in Musculoskeletal Trauma in the Elderly, 2016
Malreduction of the glenoid fossa fragment results in residual incongruity. Hardegger et al.20 had to reoperate for joint instability. Malunion of the inferior scapular angle was recorded by Bartoníček et al.14 Several cases of hetero-topic ossification have been described, in one of which there occurred entrapment of the axillary nerve requiring surgical decompression.18 Acromial impingement after internal fixation of the glenoid has had to be treated by acromioplasty.23 Prominence of implants, requiring their removal, is a problem mainly in fractures of the acromion, scapular spine, or associated clavicular fractures.18,30 One report also describes a late infection, 11 months after operation, requiring hardware removal.23 In addition, one breakage of a plate was recorded after several years in a healed scapular fracture.23
Mechanisms of Modulation of Automatic Scapulothoracic Muscle Contraction Timings
Published in Journal of Motor Behavior, 2021
Samuele Contemori, Roberto Panichi, Andrea Biscarini
Scapular movements in the transverse body plane, such as the retraction/protraction, result from precise and synchronized mechanics between the sternoclavicular and acromioclavicular joints whose complete determination was, however, not accomplished in the present study. Nonetheless, we indexed the modification of the scapular position relative to the neutral posture, by quantifying the degrees of rotation of the clavicle in the transverse plane (i.e., around the vertical axis of the sterno-clavicular joint). To do that, we firstly computed an estimation of each participant’s length of the clavicle shaft from the distance between the acromion-mounted marker and a marker that was mounted on the jugular incisure of the sternum. We then computed degrees of rotation of the clavicle from the anterior-posterior and medio-lateral displacements of the acromion-marker, relative to the neutral scapular position. Although being far from an accurate delineation of the scapular kinematics, this measure provides an understating of the extent to which the participant modified the initial shoulder asset by either protracting or retracting the scapula.
Acromioclavicular joint injuries at a Colorado ski resort
Published in The Physician and Sportsmedicine, 2023
Naomi Kelley, Lauren Pierpoint, Jack Spittler, Morteza Khodaee
Acromioclavicular joint (ACJ) injuries (also known as separations or dislocations) are very common, accounting for up to forty percent of all shoulder injuries [1–4]. The AC joint is a diarthrodial joint where the clavicle can rotate and translate anteriorly, posteriorly and inferiorly in relation to its articulation with the acromion. The joint is composed of a meniscus-type structure of hyaline cartilage, surrounded by synovium [2]. Stability of the ACJ is provided horizontally by the acromioclavicular ligament, and vertically by the coracoacromial ligament. Although not directly attached to the acromion, two coracoclavicular ligaments (conoid and trapezoid ligaments) provide further vertical stability to the joint [5]. Overall, the anatomy of the ACJ provides resistance against significant forces.
Surgical treatment, complications, and reimbursement among patients with clavicle fracture and acromioclavicular dislocations: a US retrospective claims database analysis
Published in Journal of Medical Economics, 2019
Matthew Putnam, Mollie Vanderkarr, Piyush Nandwani, Chantal E. Holy, Abhishek S. Chitnis
Improved surgical methods and technologies could reduce the rate of non-planned reoperations and device removals, thereby reducing costs to the healthcare system. As an example, a prospective cohort study by Rongguang et al.10 compared the outcomes and complications of open reduction and internal fixation using pre-contoured vs non-contoured plates for the treatment of midshaft clavicle fractures. The authors found that plate removal was required in 44.9% (31 of 69) of the pre-contoured group and 65.6% (40 of 61) of the non-contoured group. The indication for plate removal was prominence of the hardware in 27.5% (19 of 69) of the pre-contoured group and 54.1% (33 of 61) of the non-contoured group. A retrospective observational study by Schemitsch et al.22 found that significant risk factors for clavicular implant removal (42 of 153, 27%) were the use of a plate that was not pre-contoured, and patient height <175 cm. The use of metal implants for AC joint dislocations can be complicated by displacement of these implants33. The hook plate is effective for fixation of grade III AC dislocations; however, it typically needs to be removed after healing to prevent potential irritation of the acromion or impingement of the rotator cuff33. Newer AC joint technologies may reduce the need for a second surgery to remove the implant33.
Related Knowledge Centers
- Acromioclavicular Joint
- Deltoid Muscle
- Shoulder Joint
- Spine of Scapula
- Coracoid Process
- Scapula
- Shoulder
- Clavicle
- Process
- Spine of Scapula
- Glenoid Fossa