OrthoDx: Acute Shoulder Pain After Fall

Slideshow

  • Figure 1. Anteroposterior radiograph of left shoulder after fall.

  • Figure 2. Coronal CT image of left shoulder.

  • Figure 3. Sagittal CT image of injured shoulder.

A 44-year-old man presents to the office with continued left shoulder pain after a fall 2 weeks ago. He tried to catch himself with his left arm and felt a pop when his arm hit the ground. He was seen in the emergency department (ED) after the incident and radiographs were taken (Figure 1). The patient followed-up with orthopedics. On physical examination of the right shoulder, the patient has tenderness to palpation over the anterior glenoid and difficulty with any active motion. Coronal and sagittal computed tomography (CT) images (Figures 2 and 3) show an anterior-inferior glenoid fracture with 6 mm of anterior-inferior displacement and loss of over 30% of the glenoid surface area.

Glenoid fractures can occur as a result of a traumatic shoulder dislocation (rim fractures) or fall that impacts the humeral head against the glenoid (glenoid fossa fracture).1 The small surface area of the glenoid compared with the large radius of...

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Glenoid fractures can occur as a result of a traumatic shoulder dislocation (rim fractures) or fall that impacts the humeral head against the glenoid (glenoid fossa fracture).1 The small surface area of the glenoid compared with the large radius of the humeral head allows the shoulder joint the most range of motion of any joint in the body. Grashey view (anteroposterior oblique) and axillary are the best radiography views to diagnose obvious glenoid fractures. However, a CT scan is often necessary to determine the amount of displacement or to confirm subtle fractures.1,2

Most glenoid fractures have minimal displacement and can be treated nonoperatively. Generally, intra-articular fractures with less than 4 mm of displacement and involving less than 25% of the glenoid can be treated with shoulder immobilization. Young athletes with bone loss to the glenoid are at the highest risk of recurrent instability and are more likely to require surgery. Glenoid fractures with significant displacement and involving more than 25% of the glenoid are generally treated with open reduction and internal fixation (ORIF).1,2

Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor in chief of the Journal of Orthopaedics for Physician Assistants.

References

1. Seidl AJ, Joyce CD.  Acute fractures of the glenoid. J Am Acad Orthop Surg. 2020;28(22):e978-e987. doi:10.5435/JAAOS-D-20-00252

2. Van Oostveen DPH, Temmerman OPP, Burger BJ, Van Noort A, Robinson M. Glenoid fractures: a review of pathology, classification, treatment and results. Acta Orthop Belg. 2014;80(1):88-98.

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