acromion; (2) type II fractures through the acromion just posterior to the acromioclavicular joint; and (3) type III fractures, which are displaced fractures of the posterior acromion or scapular spine (Crosby et al., 2011). The most common symptoms of scapular fracture are swelling at the fracture site and pain with movement of the upper extremity (Gage, 2023). Clinical Presentation Clinical presentation includes pain, limited use of the upper extremity, swelling, and visible deformity. The deformity is usually a varus angulation for most fractures located distal to the deltoid tuberosity. For fracture lines between the pectoralis major insertion and the deltoid tuberosity, the deformity is usually a valgus angulation. Because of the location of the valgus angle fractures, radial nerve function should be tested (Gallusser et al., 2021). According to Gallusser et al. (2021), the examiner should be sure the wrist is in a neutral position before examining finger extension, as lumbrical muscle function can be mistaken for intact radial nerve function.
fractures can be hard to recognize because of the complex geometry of the structure and the degree of individual variation in shape (Pinto et al., 2018). Scapular fractures have been associated with reverse total shoulder arthroplasty at a frequency of about 5% (Sußiek et al., 2021). These fractures are seen in three locations: (1) Type I fractures with small avulsions of the anterior Humeral shaft fracture Humeral shaft fractures typically occur in two distinct age groups: (1) men ages 21 to 30 years following high-energy trauma such as a motor vehicle crash that commonly results in comminuted fractures with associated soft tissue injuries and (2) women ages 60 to 80 years, who often sustain humeral shaft fractures following low-energy trauma such as a fall from a standing position (Gallusser et al., 2021).
ELBOW PAIN/INJURIES
Medial epicondylitis This injury has been described as an angiofibroblastic tendinosis of the flexor-pronator tendon origins at the site where the flexor carpi radialis and pronator teres join (Barco & Antuña, 2017). Radiculopathy at C6 and C7 is associated with medial epicondylitis (Lee & Lee-Robinson, 2010). It is most common in patients ages 50 to 60 years and is four times less common than lateral epicondylitis (Park et al., 2021). Activities that often aggravate this pain include golf, weightlifting, swimming, tennis, and work-related activities ((Barco & Antuña, 2017). The group of flexor-pronator muscles includes the pronator teres, flexor carpi radialis, palmaris longus, flexor digitorum superficialis, and flexor carpi ulnaris, all of which attach to the medial epicondyle. The pronator teres and flexor carpi radialis attach to the proximal aspect of the anterior part of the medial epicondyle. These tendons are stretched when valgus forces are applied to the elbow, such as in throwing activities (Donaldson et al., 2014). Differential diagnosis should include C6 and C7 radiculopathy, ulnar collateral ligament injury, and ulnar nerve issues. The ulnar collateral ligament attaches proximally at the medial condyle and distally at the base of the coronoid process. This ligament functions to Lateral epicondylitis Lateral epicondylitis is the most common cause of lateral elbow pain (Keijsers et al., 2018). It is caused by repetitive microtrauma from excess gripping or wrist extension, radial deviation, and/or forearm supination (Ma & Wang, 2020). Clinical Presentation Clinical presentation includes lateral elbow pain that usually radiates distally along the extensor muscle mass and is exacerbated by wrist and finger extension against resistance (Johns & Shridhar, 2020). The extensor carpi radialis brevis is the most frequently affected muscle, partly due to its unique origin at the lateral aspect of the capitellum (Ma & Wang, 2020).
resist valgus stresses to the elbow and should be tested for stability. The ulnar nerve passes through the medial intermuscular septum, approximately 8 cm above the medial epicondyle. It then runs posterior to the medial epicondyle in the cubital tunnel before passing between the two heads of the flexor carpi ulnaris. It can be assessed via Tinel’s sign (tapping along the nerve to see if it produces tingling or pain) as well as a neurological exam including sensory and motor assessment (Donaldson et al., 2014). Clinical Presentation Clinical presentation typically involves tenderness just distal and medial to the medial epicondyle over the insertion of the flexor-pronator (Donaldson et al., 2014). According to Barco & Antuña (2017), the elbow typically retains full range of motion; however, flexion contractures may be present (Donaldson et al., 2014). Pain is exacerbated by resistance to wrist flexion and pronation. When resisting pronation, the elbow should be flexed to 90 degrees to isolate the pronator teres (Donaldson et al., 2014). Grip strength is often reduced (Donaldson et al., 2014), and weakness may be found in the wrist flexors and forearm pronators ( (Barco & Antuña, 2017). History and physical examination are used to confirm a diagnosis of lateral epicondylitis. History should include occupation, hand dominance, hobbies and activities, onset and duration of symptoms, and aggravating factors (Ma & Wang, 2020). Physical examination should include resistance to middle finger extension, which is positive when it reproduces lateral elbow pain. This selectively recruits the extensor carpi radialis brevis tendon. Handgrip weakness is common (Ma & Wang, 2020).
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