EMERGENCY DEPARTMENT EVALUATION AND TREATMENT OF THE SHOULDER AND HUMERUS

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The shoulder girdle is a versatile anatomic structure with a wide range of mobility and function. Its soft tissue and skeletal components are subject to a litany of injuries, spanning overuse syndromes to acute trauma. The use of key history and physical examination techniques with proper imaging in the emergency department (ED) will aid in the diagnosis of specific disorders. Once a diagnosis is made, surgical consultation can be obtained versus more conservative therapy initiated, including immobilization or early rehabilitation.

Section snippets

ANATOMY

The shoulder is the most mobile joint in the body, with greater than 180 degrees of motion in both the sagittal and coronal planes as well as 180 degrees of rotatory movement. The bony components provide structure and stability, whereas the soft tissues provide fluid motion. The skeletal components of shoulder include the clavicle, scapula, and humerus.

The scapula is the focal point for the shoulder girdle, providing the origin of the rotator cuff and articulation with both the clavicle and

IMAGING

In the ED, radiologic studies of the shoulder usually are limited. A standard series most likely includes an internally rotated anteroposterior (AP) view and either a transcapular-Y view or an axillary view as a lateral projection. Either the transverse-Y view or an axillary view must be obtained if there is any concern about glenohumeral dislocation. Some centers incorporate an externally rotated AP view into their standard shoulder series. Lordotic views can be used to evaluate the

SOFT TISSUE

The extensive range of mobility, combined with its unique anatomic structure, makes the shoulder prone to an array of soft tissue disorders. These disorders form a continuum ranging from an isolated tendonitis to a complete rupture of the rotator cuff. The common thread in this continuum of disorders is impingement. Impingement occurs in the subacromial space that lies between the coracoacromial arch and the humeral head. Contained in this space are the tendons of the rotator cuff, the long

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    Address reprint requests to Robert Blake, MD, Madigan Army Medical Center, Tacoma, WA 98431

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