锁骨骨折课件_2.ppt

Injuries of the Clavicle, Acromioclavicular Joint and Sternoclavicular Joint Andrew H. Schmidt, MD T.J. McElroyCreated March 2004 Clavicle “S”-shaped bone Medial - sternoclavicular joint Lateral - acromioclavicular joint and coracoclavicular ligaments Muscle attachments: Medial: sternocleidomastoid Lateral: Trapezius, pectoralis major AC Joint Diarthrodial joint between medial facet of acromion and the lateral (distal) clavicle. Contains intra-articular disk of variable size. Thin capsule stabilized by ligaments on all sides: AC ligaments control horizontal (anteroposterior ) displacement Superior AC ligament most important Distal Clavicle Coracoclavicular ligaments “Suspensory ligaments of the upper extremity” Two components: Trapezoid Conoid Stronger than AC ligaments Provide vertical stability to AC joint Mechanism of Injury Moderate or high-energy traumatic impacts to the shoulder Fall from height Motor vehicle accident Sports injury Blow to the point of the shoulder Rarely a direct injury to the clavicle Physical Examination Inspection Evaluate deformity and/or displacement Beware of rare inferior or posterior displacement of distal or medial ends of clavicle Compare to opposite side. Physical Examination Palpation Evaluate pain Look for instability with stress Physical Examination Neurovascular examination Evaluate upper extremity motor and sensation Measure shoulder range-of-motion Radiographic Evaluationof the Clavicle Anteroposterior View 30-degree Cephalic Tilt View Radiographic Evaluation of the Clavicle Quesana 45-degree angle superiorly and a 45-degree angle inferiorly Provide better assessment of the extent of displacement Radiographic Evaluation of the AC Joint Zanca View AP view centered at AC joint with 10 degree cephalic tilt Less voltage than used for AP shoulder Stress Views of the Distal Clavicle AC Joint Rationale: will demonstrate instability and differentiate grade III AC separations from partial Grade I-II injuries Performed b