Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e
|Section 22. Injuries to Bones and Joints >|
Chapter 268. Shoulder and Humerus Injuries
Sections: Sternoclavicular Sprains and Dislocations, Clavicle Fractures, Scapula, Acromioclavicular Joint Injuries, Dislocation of the Glenohumeral Joint, Humerus Fractures, Brachial Plexus Injuries, Acknowledgment, References.
Topics Discussed: humerus injuries; shoulder injury.
Excerpt:"The sternoclavicular joint is the most frequently moved, nonaxial
joint of the body. It also has the least amount of bony stability
of any major joint because less than half of the medial end of the
clavicle articulates with the upper sternum. Therefore, joint stability
depends on the integrity of the surrounding ligaments, which give
the sternoclavicular joint surprising strength. As a result, the
majority of injuries to this area are simple sprains, and dislocations
and fractures are uncommon.Patients with uncomplicated anterior dislocations may be
discharged without an attempted reduction, as this injury has little
or no impact upon function. For closed reduction, the patient
is placed supine with a towel roll or similar between the scapulae.
The arm is abducted to 90 degrees, traction is applied with slight
extension by moving the arm toward the ground, and pressure is placed
over the medial end of the clavicle.1 Even with
reduction, the joint is usually unstable and re-dislocates when
pressure is released. Clavicular splinting, ice, analgesics, and
orthopedic referral are required...."
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