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

Team Physicians

Spe r

• G Kar

as, MD E mor y Spor ts Me dic ine Ce nte r

SNAPPING SCAPUL A CASE

Midshaft Clavicle ORIF Nonunion

Team Physicians

e mo ryhe a lthc a re .o rg / o rtho

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
• 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 Physicians

e mo ryhe a lthc a re .o rg / o rtho

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 Physicians

e mo ryhe a lthc a re .o rg / o rtho

IMAGING

• Xra ys ne g a tive
• Adva nc e d I

ma g ing de fe rre d

Team Physicians

e mo ryhe a lthc a re .o rg / o rtho

ANY T HOUGHT S?

• Diffe re ntia l

Dia g no sis

• T

re a tme nt Pla n

Team Physicians

e mo ryhe a lthc a re .o rg / o rtho

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 Physicians

e mo ryhe a lthc a re .o rg / o rtho

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 Physicians

e mo ryhe a lthc a re .o rg / o rtho

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 Physicians

e mo ryhe a lthc a re .o rg / o rtho

PROCE DURE

• Pro ne po sitio n
• Wide pre p
• “Chic ke n wing ”

Team Physicians

e mo ryhe a lthc a re .o rg / o rtho

PROCE DURE

Team Physicians

e mo ryhe a lthc a re .o rg / o rtho

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 Physicians

e mo ryhe a lthc a re .o rg / o rtho

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