shoulder limb injury and its measurment traction and fracture of upper limb &splints provided.

1. INJURIES OF
UPPER LIMB
• Injuries around shoulder & fracture of
humerus
• Injuries around elbow
• Injuries of forearm & wrist
• Injuries in hand & digits
shaleen rakheja
PRESENTED BY

2. 1 Fracture of clavicle
2 Fracture of scapula
3 Dislocation of sternoclevicular joint
4 Subluxation of acromioclavicular joint
5 Dislocation of shoulder
6 Fracture of surgical neck of humerus
7 Fracture of grater tuberocity of humerus
8 Fracture of shaft of humerus
INJURIES AROUND
SHOULDER &
HUMERUS

3. • It comprises of clavicle, scapula & humerus
• The articulation gives unique ROM in all directions
SHOULDER GIRDLE
•
•
•
•
• g l e n o h u m e r a l j o i n t
• a c r o m i o c l a v i c u l a r j o i n t
• s t e r n o c l a v i c u l a r j o i n t
• s c a p u l o t h o r a c i c j o i n t

4. • It is only long bone with membranous ossification having two primary
centers
• medial 2/3 is convex anteriorly and lateral 1/3 is concave ant.
• stability provided by acromioclavicular ligament & coracoclavicular
ligament attached at conoid tubercle, trapezoid
CLAVICLE BONE
.
muscle attachment
site

5. • The scapula or shoulder blade is the bone that
connects the clavicle to the humerus.
• The scapula forms the posterior of the shoulder
girdle.
• It is a sturdy, flat, triangular bone.
SCALPULA BONE
.
Intrinsic muscles : rotator cuff muscles, teres major,
subscapularis, teres minor, infraspinatus(These assist
with abduction & externalinternal rotation of the
glenohumeral joint)
Extrinsic muscles: triceps, biceps, & deltoid.
Third group of muscles: levator scapulae, trapezius,
rhomboids & serratus anterior (responsible for
rotational movements & stabilization of the scapula)

6. • The proximal end of humerus consists of the head articulating with the glenoid cavity of the scapula.
• The head is separated from the greater and lesser tuberosities by Anatomical neck
• The globular upper end of the bone joins the tubular shaft of the bone is called the Surgical neck
HUMERUS BONE
.

7. Pathoanatomy Treatment
• common site: at the junction of the middle & outer-1/3
of the clavicle
• the outer fragment displace medially & downward by
gravity & pectoralis major muscle.
• inner fragment displace upwards by
sternocleidomastoid muscle
• Fracture unite readily, reduction of fragment is not
essential
• Triangular sling, Figure-of-8-bandage(young adults) is
sufficient
Back to Agenda 05
Fracture of clavicle
Early complication: the fracture fragment may injure the subclavian vessel or brachial
plexus

8. Pathoanatomy Treatment
• less common, not much treatment is required
• bone break at four sites: body, neck, acromion process &
coracoid process
• fracture is undisplaced because the fragments are held
in together by surrounding muscles
• treatment is to restore shoulder mobility and reduce
pain
• Triangular sling{usually 1 week-10 days}, Figure-of-8-
bandage(young adults) is sufficient
Back to Agenda 05
Fracture of scapula

9. Back to Agenda 05
Dislocation of sterno-clavicular joint
• rare injury, medial end of clavicle is displaced forward or backward
• diagnosis by clinically, x-ray
• treatment by reduction using direct pressure over dislocated part & Figure-of-8-
bandage for stabilization
Subluxation/Dislocation of Acromioclavicular
joint
• uncommon injury may result in partial or complete rupture of acromioclavicular
ligament or coracoclavicular ligaments.
• ACJ divide into Grade 1,Grade 2 & Grade 3
• G 1&2 are treated by triangular sling, G3 by surgical repair

10. PREGLENOID
SUBCORACOID SUBCLAVICULAR INTRATHORASIC
Anterior dislocation
DISLOCATION OF SHOULDER
07
• This is the most common injury of upper limb due to large head of humerus is not
stable in the glenoid more likely to dislocate. It occurs more in adults than in
children. Anterior dislocation is is much more common than posterior dislocation.
• Clinically the patient will appear with abducted & externally rotated arm.
• MDI{multidirectional intability}-anterior, inferior, posterior dislocation
PATHOANATOMY

11. • posterior dislocation: The head of the humerus comes to lie posteriorly bhind the
glenoid
• inferior dislocation(luxatio erecta): head comes lie in subglenoid position
BANKART'S
LESION
HILL-SACHS
LESION
pathological
changes
Dislocation of shoulder
Anterior inferior labrum
tear
A dent on humeral
head
Tear of top of the labrum

12. Diagnosis Treatment Reduction technique
• Dugas' test: instability to touch
opposite shoulder.
• Hamilton ruler test: because of
dislocation shoulder is flattened,
the ruler will touch the acromion &
lateral condyle of humerus
simultaneously.
• posterior & anterior dislocation will
appear in lateral view x-ray
• clinical assessment, reduction,
anesthesia
• chest arm bandage for 3 weeks
• Kocher's manoeuver :
• Traction
• External rotation
• Adduction
• Internal rotation
Early complication: Injury to axillary nerve may result in paralysis of the deltoid muscle
Dislocation of shoulder

13. Pathoanatomy Treatment
• more common in elderly people usually due to fall on
shoulder
• fracture is of 4 types:
• shaft
• head
• grater tuberosity
• lesser tuberosity
• open reduction & internal fixation
• arm abduction orthosis
can be prescribed
Back to Agenda 05
Fracture of the surgical neck of the himerus
complication: Axillary nerve palsy and shoulder stiffness

14. Pathoanatomy Treatment
• It occurs in adults, due to fall on shoulder, displaced &
comminuted, sometimes it widely separated by muscle
pull (supraspinatus muscle)
• fracture reduced by holding the shoulder abducted in
plaster cast, or by open reduction & internal fixation
Back to Agenda 05
Fracture of the greater tuberosity of the humerus
complication: Painful arc syndrome and shoulder stifness

15. Pathoanatomy Treatment
• types:
• Transverse fracture.
• Oblique fracture.
• Spiral fracture.
• Segmental fracture.
• Comminuted fracture.
• Impacted fracture.
• Buckle fracture.
• Hairline fracture.
• If your fracture is mild and your bones did not move
far out of place (if it’s non-displaced), you might only
need a splint or cast. Splinting usually lasts for three
to five weeks. If you need a cast, it will likely be for
longer, typically six to eight weeks. In both cases,
you’ll likely need follow-up X-rays to make sure your
bones are healing correctly.
• You might need a sling to hold your shoulder and arm
in place, especially if your humerus is fractured at the
proximal end near your shoulder.
Back to Agenda 05
Fracture of the shaft of humerus
complication: radial nerve injury,delayed union & non union

16. humeral fracture brace
The use of humeral fracture braces has become our
preferred method of treatment for fractures of the
shaft of the humerus. These braces are easy to apply
and adjust; the patient's acceptance of this method
of treatment is high. We compared this method of
treatment with the traditional method of plaster U-
slab immobilization. A group of patients treated with
a plaster U-slab were matched for type and level of
fracture with a group treated with a humeral fracture
brace and compared with regard to fracture healing
and functional outcome. There was no difference
between groups for healing time and final alignment
of the fracture. However, there was a greater range
of elbow motion at the time of union in the fracture
brace group (11 degrees-126 degrees) compared with
the U-slab

17. 1 Supracondylar fracture of humerus
2 Fracture of the lateral condyles of humerus
3 Intercondylar fracture of humerus
4
Fracture of medial epicondyle of the
humerus
5 Dislocation of elbow
6 Pulled elbow
7 Fracture of olecrone
8 Fracture of neck of radius
9 Fracture of capitulum
INJURIES AROUND
THE ELBOW

18. 1 Fracture of the forearm bone
2 Monteggia fracture dislocation
3 Galeazzi fracture disloction
4 Colle's fracture
5 Smith fracture
6 Barton's fracture
7 Scaphoid fracture
8 Lunate dislocation
INJURIES OF THE
FOREARM & WRIST