Neck and shoulder pain (Full Version)

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Alex Brenner PT MPT OCS -> Neck and shoulder pain (January 12, 2005 11:12:00 PM)

U.S. Army soldier is not happy with his military care so he comes to your clinic with neck and shoulder pain after conducting "combatitive training" in his unit.

What are the findings?

[IMG]http://img.photobucket.com/albums/v85/brennerak/Shoulder1.jpg[/IMG]



SJBird55 -> Re: Neck and shoulder pain (January 13, 2005 12:50:00 AM)

How old is he?
What is the blur/cloudy oval section in the rib cage left of the spine?
In the shoulder, I don't know what normal spacing between the acromion process and humeral head. And the humeral head and neck look different than I'd expect, but I don't know his age and this is only one view.
And, since I don't know anything about the military - what exactly does combative training entail?



Sebastian Asselbergs -> Re: Neck and shoulder pain (January 13, 2005 1:04:00 AM)

wow. Looks like a superior sitting humeral head with a surgical neck fracture...



Sebastian Asselbergs -> Re: Neck and shoulder pain (January 13, 2005 1:05:00 AM)

SJ, I think you're looking at the heart ("blur")



Jon Newman -> Re: Neck and shoulder pain (January 13, 2005 1:49:00 AM)

I agree with Sebastian,

Plus maybe an AC seperation.

jon



Alex Brenner PT MPT OCS -> Re: Neck and shoulder pain (January 13, 2005 3:22:00 AM)

Hi. Combatitive training is basically where the soldiers go out and do hand to hand combat for training. They pretty much beat the crap out of each other with their bare hands. Maybe like ultimate fighting but with some rules. I am always seeing soldiers in the clinic with injuries from this training but the command lets them do it because it is tough realistic training and the soldiers love it.



Alex Brenner PT MPT OCS -> Re: Neck and shoulder pain (January 13, 2005 3:24:00 AM)

SJ, the circled object is the heart. Is this what you were referring to?

The soldier is 18 years old.

[IMG]http://img.photobucket.com/albums/v85/brennerak/Shoulder2.jpg[/IMG]



Synergy -> Re: Neck and shoulder pain (January 13, 2005 8:33:00 AM)

AC joint subluxation? I'm also in agreeance with Sebastian...superior humeral head with surg. neck fx. Potential SLAP lesion present secondary to impact trauma?



chiroortho -> Re: Neck and shoulder pain (January 13, 2005 9:30:00 AM)

Anterior shoulder dislocations are much more common than posterior dislocations due to the foramen of Weitbrecht in the anterosuperior glenohumeral ligament (remember that it has 3 bands).

In an 18 year old soldier, the physis would not necessarily be closed, which would mimic a fracture. This radiograph does not demonstrate a physeal injury or fracture. The physis appears to be normal.

Clinical pearl: The Hill-Sachs lesion is essentially a divot on the posterosuperior humeral head that results from repeated anterior glenohumeral dislocations. The Bankart lesion can also result from glenohumeral dislocations.

The AC joint on this view is normal.



Alex Brenner PT MPT OCS -> Re: Neck and shoulder pain (January 13, 2005 9:47:00 AM)

Hi. Greg is correct concerning the humerus. These are the epiphyses of his humerus and are normal; commonly mistaken as fractures. The pathology is elsewhere. Keep looking!



pablo w -> Re: Neck and shoulder pain (January 13, 2005 10:54:00 AM)

Am I imagining a fracture line through the clavicle, visisible on the inferior aspect midway between the line from coracoid to superior angle of the scapula? I had to check that it wasn't something on my screen, and the more I look at it, the more it looks like a fracture.



chiroortho -> Re: Neck and shoulder pain (January 13, 2005 12:00:00 PM)

Funky scapula, more specifically, funky orientation of the acromion, looks like a pseudoarthrosis.



SJBird55 -> Re: Neck and shoulder pain (January 13, 2005 5:18:00 PM)

The heart... silly me. I didn't realize you could actually see the heart. Good to know he has one! :)

I didn't know if those were the epiphyses which is why I asked age.

Can I ask another question before I take my next guess? In this combat drill stuff are the soldiers always on their feet the whole time, or is it common for them to fall? By any chance to they wear any type of protective gear? And... are there any rules of what is allowed and what isn't allowed? In a round about way, I'm wondering about mechanism of injury. What I'm thinking of guessing doesn't seem to make sense to me....



Sebastian Asselbergs -> Re: Neck and shoulder pain (January 14, 2005 1:34:00 AM)

Thanks Greg and Army. I forgot to ask the age.... They do take 'm young. I was 21 when entering the army.
Is that scapula sitting further in protraction than common? How is the cervical exam (including C-T junction)?



Shill -> Re: Neck and shoulder pain (January 14, 2005 4:33:00 AM)

Glenoid fracture? The C spine is hard to see from this view, for an amateur such as myself. Got any other views?
Steve



g_rowe -> Re: Neck and shoulder pain (January 14, 2005 4:44:00 AM)

Humeral head looks askewed? Not a good thing when it looks like the head of the humerus would rather articulate with the acromion rather than the glenoid fossa?



chiroortho -> Re: Neck and shoulder pain (January 14, 2005 6:16:00 AM)

Type I acromion.



Alex Brenner PT MPT OCS -> Re: Neck and shoulder pain (January 14, 2005 11:12:00 AM)

Wow. These are all great questions. Shill, I think, brings up the most important question. Where is the second view? I learned from a radiologist early on that "One view is No view". I do not have a second view to post but it would be imparative to have it for this study. Unfortunately for you, this is all the pateint brought into the clinic.

Greg and Jerry, you are correct, this view is kind of funky and adds to the difficulty of this study.

Shill, the soldiers do not wear any protective gear and it is common for the combat training to end up on the ground in a wrestling-type of match. Very violent and can cause some decent traumatic type injuries. Interestingly enough, this combat training rarely ends up in "fights" between soldiers. Strictly training.

I will post the findings in 4 days. Keep guessing!



SJBird55 -> Re: Neck and shoulder pain (January 14, 2005 12:23:00 PM)

I figured you didn't have a second view... I've been told the same thing - never to come up with a conclusion with what is viewed with only one view.
Then, I'll just guess the first and second rib near the spine maybe there is something?



Randy Dixon -> Re: Neck and shoulder pain (January 14, 2005 3:09:00 PM)

I don't know diddly about radiography but I do know about combatives. My guess is this guy was thrown and ended up landing on the tip of his shoulder. To me the humeral head looks jammed in there, maybe slight anterior dislocation and their is an minor AC separation.



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