• What structures causes the shoulder (glenohumeral) joint to be highly mobile but relatively stable
• The relatively poor bony congruence between the gleniod and humeral head and a slack capsule
• What structure provides the strongest support for the AC joint?
• The coracoclavicular ligament which descends from the distal clavicle to the coracoid process. The ligament must be torn to produce the major stepdown of the acromion below the clavicle in grade 3 acromioclavicular joint injuries
• What other causes of shoulder pain?
Can the pain be referred?
What else?
• Pale• Clammy• Pain in epigastrum
Positive Kehr’s Sign
What is it?
Left shoulder pain
• Free intraperitoneal blood
• Diaphragmatic irritation
Kehr’s Sign, neglected aid in rupture of the spleen
New England Journal of Medicine
Name some other symptoms of spleen injury?
Splenic Injury
• Generalize abdominal pain• Left shoulder pain• Aggravated by deep pressure of left
hypochondrium• Tenderness to rectal palpation• Slight increase in temperature• FAST test
What is the most commonly injured viscous in blunt trauma?
Spleen the most commonly injured viscous in blunt
abdominal trauma
Delayed rupture presenting as unstable angina pectoralis
What causes a delayed rupture spleen?
Causes of the delayed bleed?
• Tamponade (old blood clots)
• Subscapular hemorrhage
• Small tamponade forms clot on omentum or bowel laceration
• Subscapular hemorrhage may be present for several days before rupture of the capsule takes place
How long can the delayed rupture occur?
Delayed
• Less than an hour and Up to 14 days• Several months• 21% delayed
Journal of Trauma 2008
• 673 non operative spleen• Mild – 12.5 heal• Severe – 37 days• 20% not heal after 3 months• 10% worse as outpatient