SNAPPING SCAPUL A CASE Midshaft Clavicle ORIF Nonunion Spe r o G - PowerPoint PPT Presentation

SNAPPING SCAPUL A CASE Midshaft Clavicle ORIF Nonunion Spe r o G Kar as, MD E mor y Spor ts Me dic ine Ce nte r Team Physicians

INIT IAL PRE SE NT AT ION • 23 ye a r o ld fe ma le pre se nts fo r rig ht po ste rio r sho ulde r pa in. • I nsiduo us o nse t while wo rking a s a ha irdre sse r 6 mo nths a g o • Co mpla ints o f po pping , pa in, a nd spa sm o ve r SMB o f rig ht sc a pula • I nitia l Rx with NSAI Ds, fo a m ro lle r, ma ssa g e , a nd, he a ting pa d Team e mo ryhe a lthc a re .o rg / o rtho Physicians

PHYSICAL E XAM • No a tro phy o r fra nk sc pa ula r wing ing , b ut mild dyskine sis o n F E • Mildly te nde r to pa lpa te o ve r sc a pula r SMB • Symme tric stre ng th e xa mina tio n • Symme tric sc a pula r mo tio n with no wing ing • I mping e me nt, Spe e d’ s a nd Ac tive Co mpre ssio n te sting ne g a tive • Pa lpa b le a nd a udib le c re pitus a t SMB Team e mo ryhe a lthc a re .o rg / o rtho Physicians

IMAGING • Xra ys ne g a tive • Adva nc e d I ma g ing de fe rre d Team e mo ryhe a lthc a re .o rg / o rtho Physicians

ANY T HOUGHT S? • Diffe re ntia l Dia g no sis • T re a tme nt Pla n Team e mo ryhe a lthc a re .o rg / o rtho Physicians

PL AN • Dia g no se d with SMB Syndro me / Sna pping Sc a pula • Pla n – CSI into SMB – NSAI Ds – Physio the rpa y • Sc a pula r sta b iliza tio n • Mo da litie s Conduah , 2010 Team e mo ryhe a lthc a re .o rg / o rtho Physicians

T HRE E MONT H F / U • Ne a r c o mple te re so lutio n o f pa in fo r 6 we e ks • Pa in ha s no w re turne d • Cre pitus- mild impro ve me nt • Dyskine sis impro ve d? Team e mo ryhe a lthc a re .o rg / o rtho Physicians

SURGICAL INDICAT IONS • Use T hre e Stric t I ndic a tio ns – Pa lpa b le c re pitus a t SMB – Audib le Cre pitus a t SMB – >50% sub je c tive impro ve me nt with SMB inje c tio n Team e mo ryhe a lthc a re .o rg / o rtho Physicians

PROCE DURE • Pro ne po sitio n • Wide pre p • “Chic ke n wing ” Team e mo ryhe a lthc a re .o rg / o rtho Physicians

PROCE DURE Team e mo ryhe a lthc a re .o rg / o rtho Physicians

POST - OP • Sling 3 da ys • ADL s a s to le ra te d • Pro g re ssive re ha b fo r ro m, stre ng th sc a pula r re ha b Team e mo ryhe a lthc a re .o rg / o rtho Physicians

POST - OP • POD 2 – Sling re mo ve d – Physic a l the ra py fo r ro m, stre ng th, sc a pula r re ha b • POW 3 – Ne a r c o mple te re so lutio n o f sympto ms – Co ntinue Re ha b – RT W • POW 8 – Disc ha rg e d with no re stric tio ns Team e mo ryhe a lthc a re .o rg / o rtho Physicians