Shoulder Injuries

NB - With ALL shoulder injuries, test nerves and circulation to upper limb.

Fracture clavicle                                                      
Broad arm sling. Refer Virtual Fracture Clinic (VFC)

Fracture scapula (beware of other injuries as it take a lot of force to fracture the scapula)
Broad arm sling and refer VFC.

Fracture greater tuberosity                                  
Sling, Refer VFC.                                                          

Anterior dislocation SC joint          
Ask advice

Dislocation/subluxation AC joint                           
Broad arm sling. Review clinic. If marked skin tenting, refer fracture clinic

Posterior dislocation SC joint                                 
Ask advice

Fracture surgical neck humerus                            
Test axillary nerve, Collar & Cuff/Sling. Refer VFC.

Fracture shaft of humerus                                      
Test radial nerve. If radial nerve deficit refer Ortho On-call. Otherwise Humeral brace/ POP 'U' slab & Collar and Cuff. Refer VFC. Ask advice if significantly displaced. 

Anterior Dislocation of shoulder                            
Test axillary nerve and other nerves pre-reduction AND DOCUMENT. Reduce. Recheck nerves. Post reduction x-ray. Shoulder immobiliser. Refer VFC.

Dislocation shoulder associated with fracture greater tuberosity
Treat as for dislocation.

Dislocation shoulder, associated with fracture surgical neck                                     
Refer orthopaedics, seek senior advice.

Soft tissue shoulder injuries                                                 
Broad arm sling for short time (2-3 days) only if necessary for symptomatic relief. Review clinic 2 weeks if necessary.

Rupture long head biceps                                        
Refer to Physiotherapy

Shoulder injuries with the exception of displaced fracture neck of humerus are treated in a broad arm sling NOT a collar and cuff