What Is Clavicular Osteolysis?

HPI: Ms. Smith presents to the office with bilateral shoulder stiffness and lateral elbow pain in right arm. The patient has been suffering shoulder stiffness for over 2 years. The symptom developed gradually after she started using her computer more at her work place; she had to hold her telephone between her shoulder and head while typing information on computer. The pain in right elbow stated about 8 months ago with gradual onset. The patient does not recall any trauma to the shoulder and elbow. She has been diagnosed as tennis

The patient was an active participant in both contact as well as non-contact athletic activities. The patient reported occurrence of different symptoms that included; pain, weakness, instability, paresthesia, crepitus, as well as instability of the shoulder during sleep. Sulculus sign was conducted to assess the rotator interval and load and shift test for determination of the patient’s posterior stability. The doctor diagnosed positive for multidirectional instability. The patient’s multidirectional instability was not caused by a traumatic event. The patient had not exercised the joint over a long period of time, hence he had a weak shoulder joint, particularly the rotator cuff. The doctor recommended that the patient should be treated for the pain and inflammation of the shoulder caused by the multidirectional instability and then placed on physical therapy aimed for one year aimed at helping in the strengthening of the muscles of the patient that support the scapula (shoulder blade) and the rotator cuff (shoulder joint) so as to help the patient in returning to normal physical activity and also prevent an injury at the same place

^8,5 ASI occurs when the arm is in adduction with the shoulder internally rotated. The biceps complex pulley, also known as a capsuloligamentous complex, adjoins the anterior glenoid causing injury when in extreme motions. With the PSI, the pulley is put into risk with abduction and external rotation on the posterosuperior glenoid. ^8 PSI is also associated with partial-thickness tears on the deep side of the articular surface of the rotator cuff. ^5 This can be a common cause for a peel-back mechanism associated with a SLAP lesion. ^8 Peel-back mechanisms can be produced many different ways, but are mostly seen with a SLAP lesion or internal impingement. These can occur when the shoulder is placed into abduction and extreme external rotation with a torsional force added to the labro-bicipital complex that is at the base of the biceps on the posterior superior labrum. ^1,5 This causes fatigue and failure of the humeral head that rotates medially over the upper rim of the glenoid fossa creating a shearing force. ^1,5 Increased superior labral strain in overhead athletes occurs during the late-cocking phase of throwing when arm is externally rotated. ^1

Examination of the bilateral shoulder reveals tenderness to palpation about the anterior shoulders bilaterally. There is also restricted range of motion secondary to pain and her supraspinatus weakness and Hawkins’ impingement tests are both positive. In addition, Neer’s impingement and drop-arm tests are also positive.

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*insert article *attachedBesides being able to see the inside of a shoulder, doctors use different physical tests to evaluate the shoulder in order to determine what type of injury and how severe an injury may be. One such test was recently developed by Dr. Carl J. Basamania at the Womack Army Medical center in Fort Bragg, N.C. The test was developed to evaluate shoulder instability in a patient. During the test the Dr. or examiner stands next to the patient who is to lay flat on his/her back. The hand of the examined should is held firmly by the examiner. The examiner then pushes against the clavicle to stabilize th scapula, while they also gently hold the pectoral muscle with their thumb in order to be able to assess relaxation. The examiner then rotates the arm form neutral to full external rotation. If the patient has AIGHL incompetence there is a lack of tightening as the arm reaches full external rotation. The test has appeared to be highly accurate and may be of value to Dr.'s and surgeons alike. After doctors have determined what type and what degree of injury a patient has sustained using various tests it is on to the next step, rehabilitation.

S: In 10/22/2014, TM was seen for bilateral shoulder pain. Today TM is here complains of left shoulder pain. According to TM he was aligning a Santfa, a process involving reaching. When he was bring his arm down, he felt the sharp, tearing pain in his anterior of his shoulder. TM is here with left shoulder pain. TM reports his pain at 6-7/10. The pain was sudden, sharp at The pain was localized, and didn’t radiated to anywhere else. The pain was so sudden and so severe, it scared him. TM denies any tingling or numbness, loss of movement.

DOI: 3/5/2015. Patient is a 53-year old male coordinator who sustained injury to his right shoulder and right arm, when he slipped and fell while walking into work. Per OMNI, he was initially diagnosed with fracture of the right humerus and contusion of the right elbow. This claim is established only for the right shoulder and elbow.

However, plain films were not obtained. There is no clear rationale for the indication of shoulder MRI with unequivocal objective findings and absence of plain films. In addition, there is no focal neurological deficit on the exam. There are no sensory or motor deficits noted. Medical necessity has not been established. Recommend non-certification.

this made Adrian’s shoulders seem a bit more symmetrical, but not entirely. The therapist further tested the AC joint by pulling the humerus back , placed it at a 15 degree angle, bent at the elbow, and pulled his arm dorsally; Adrian’s shoulder could not resist. This indicated a C5/C6 issue of an AC separation due to a small bump on his right shoulder. Got rid of the bump by relocating the AC joint and yet still not strength in his shoulder; this was indicative on some actual nerve damage. The therapist had one more trick up his sleeve and so he decided to adjust Adrian’s 1st rib. Once he did that Adrian got his shoulder strength back. It turns out that Adrian had thoracic outlet syndrome which was affecting his coracobrachialis muscle which

Therefore, numerous spectrums of instability types and associated lesions affecting capsuloabral, ligamentous, and osseous structures can be identified (Stayner et al., 2000). The pathophysiology of an anterior shoulder dislocation involves violent external rotation in abduction levers causing the humerus to be dislodged from the glenoid socket, tearing the shoulder capsule and detaching the labrum from the glenoid (the Bankart lesion) (Farber et al., 2006). Additionally, the posterior part of the humeral head exits the joint, colliding with the anterior rim of the glenoid, producing a bony depression at the back of the humeral head (the Hill Sachs lesion) (Farber et al., 2006). Furthermore, anterior dislocation can occur when people fall with a combination of abduction, extension, and a force directed posteriorly on the arm; this is a common mechanism in the elderly (Stayner et al. 2000). A fracture of the humeral head, neck or greater tuberosity can occur with a dislocation (Stayner et al., 2000). In contrast, a posteriorly dislocated shoulder is less common. It is commonly caused by external forces acting on the shoulder when the shoulder is held in internal rotation and adduction caused by direct trauma experienced during sporting activities (Hegedus et al., 2008). Additionally, it may be result from an epileptic fit,

Shoulder impingement syndrome may also be referred to as "subacromial" impingement syndrome because the tendons, ligaments, and bursa under the "acromion" can become pinched or compressed.

4. Discussion Shoulder pain is a frequent complaint and may develop from a variety of factors. The exact cause of pain in the shoulder is often difficult to identify; thus, there has been an ongoing search for more accurate non-invasive methods. For the evaluation of the muscle injury and its related nerve, both MRI and EMG are regularly used in clinical practice (2).

DOI: 09/06/2013. This is a case of a 57-year-old female biometric technician who sustained a work-related injury to her right shoulder when she grabbed an elderly gentleman with her right arm to prevent him from falling or hitting his head. As per OMNI entry, patient was diagnosed with shoulder strain. Per progress report dated 4/26/2016, patient presents for follow up evaluation and continues to complain of constant right shoulder pain over the acromioclavicular joint. Patient had two intra-articular steroid injections that provided significant relief. She is requesting for an additional shot at the time of visit. She rates her pain at 7/10 on a pain scale. Patient reports that Norco relieves the pain at 4/10 for 3-4 hours with received therapy

The shoulder joint is extremely flexible compared to the rest of the joints in the body. This flexibility is partly due to the fact that it is a ball and socket joint. By being a ball and socket joint it means that it is capable of circumduction, angular, and rotational movement. It allows one’s arm to move up, down, to the right, to the left, and in a circle. Because it has a large range of movement, it is unstable and easily damaged. To make up for this, it has many ligaments and tendons to keep it in place. In addition, it also has the glenoid labrum which deepens the shallow glenoid cavity and makes it more stable.