Acute shoulder injuries

The shoulder is the most mobile joint in the human body. The cost of such versatility is an increased risk of injury. It is important that family physicians understand the anatomy of the shoulder, mechanisms of injury, typical physical and radiologic findings, approach to management of injuries, and indications for referral. Clavicle fractures are among the most common acute shoulder injuries, and more than 80 percent of them can be managed conservatively. Humeral head fractures are less common and usually occur in elderly persons; 85 percent of them can be managed nonoperatively. Common acute soft tissue injuries include shoulder dislocations, rotator cuff tears, and acromioclavicular sprains. Acromioclavicular injuries are graded from types I to VI. Types I and II are treated conservatively, types IV to VI are treated surgically, and there is debate about the best approach for type III. Eighty percent of shoulder dislocations are anterior. Diagnosis of this injury is straightforward. The injury usually can be reduced by employing a number of nonsurgical techniques. Traumatic or acute rotator cuff tears can be managed conservatively or surgically, depending on the patient and the degree of injury.