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Jeff Allen Director of Sports Medicine University of Alabama.
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Transcript of Jeff Allen Director of Sports Medicine University of Alabama.
ON THE FIELD MANAGEMENT OF SHOULDER
INJURIES
Jeff Allen
Director of Sports Medicine
University of Alabama
SHOULDER STATISTICS Football
13% of all reported time loss injuries3rd highest (knee, ankle)Avg. time loss of 7 days
High School Survey10% of all time loss injuries (2005-2010)
Datalys Center, NCAA Injury Surveillance Program
OBJECTIVES IN ON THE FIELD MANAGEMENT OF INJURIES
Rule out/manage life or limb threatening injuries
Determine the extent of the injury
Determine Transportation Options/Method
Make a Return to Play Decision
IS THERE A LIFE-THREATENING INJURY???
Airway
Breathing
Circulation
Disability LOC
ALERT VERBAL PAIN UNRESPONSIVE
IS THERE A LIMB-THREATENING INJURY?
Vascular compromise
Open fracture
Overlying skin integrity
Neurological compromise
MANAGEMENT OF LIFE/LIMB THREATENING INJURIES
Short-term-Deal with ABCD’s
Medium-term-Manage injury/plan to transport
Long-term-Management plan-Notification
LIFE/LIMB THREATENING INJURIES TO SHOULDER
Fractures Clavicle Scapula Humerus
DislocationsGHSC
C-Spine????
FRACTURES Damage to the bone is
the secondary concern
Primary concern is the damage the bone does to the surrounding structures
Evaluate Neurovascular Function Distally
CLAVICLE FRACTURE Mechanism
Fall on Outstretched Hand
Signs and Symptoms Sudden pain Tenderness Loss of shoulder
function Deformity(rapid
swelling/bony deviation)
Head tilt towards side of fracture
Crepitus
SCAPULA FRACTURE Mechanism
Direct trauma Indirect trauma from fall
(on shoulder or arm) Infrequent
Signs and Symptoms Sudden pain
Painful abduction
Loss of function Tenderness
(direct/indirect) Possible crepitus
HUMERUS FRACTURE Mechanism
Direct trauma Fall on an outstretched
arm
Signs and Symptoms Sudden pain Loss of function Tenderness Deformity Rapid Swelling
Proximal or Shaft
DISLOCATIONS OF THE SHOULDER
Mechanisms Direct blow Fall on Outstretched Arm MDI
Signs and Symptoms Deformity Loss of motion
Neurovascular Status!!
POSTERIOR SC DISLOCATION
Mechanism Anterior dislocations of the SCJ are much more
common (by a 9:1 ratio) Direct blow Fall on Outstretched Arm
Signs and Symptoms Pain and Deformity Altered Neurovascular Status
Complications may include: Pneumothorax Laceration of the superior vena cava Occlusion of the subclavian artery or vein Disruption of the trachea.
SECONDARY ISSUES WITH FRACTURES/DISLOCATIONS Pneumothorax
Hemothorax
Tracheobronchial injury
Neurovascular Injuries
NEUROVASCULAR STATUS!!!
PMSCPULSEMOTORSENSORYCAPILLARY REFILL
NON-LIFE THREATENING INJURIES TO THE SHOULDER
YOU CAN RELAX NOW!AC SPRAIN
SC SPRAIN
BPSI/NERVE INJURY
PEC RUPTURE
TRANSPORTATION OPTIONS
RETURN TO PLAY CRITERIA ROM
STRENGTH
FUNCTIONAL ABILITY
CONCLUSION
Don’t complicate the obvious
“Boy Scout” Philosophy
Understand potential life/limb threatening injuries
Always remember to check neurovascular status!