Floating Shoulder, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions

This book describes Floating Shoulder, Diagnosis and Treatment and Related Diseases

I came across this disorder while I was doing research on clavicle injury which one of my patients had a few weeks ago.

It intrigued me so I dug further into this condition which is basically a fracture of the clavicle (collar bone) and another fracture of the upper part of the scapula (shoulder blade) which left the shoulder floating and non-functional.

The shoulder dislocates out of place and appears like it is floating.

The term 'floating shoulder' is a rare injury comprising ipsilateral fractures of the clavicle and glenoid neck.

The Superior Shoulder Suspensory Complex (SSSC) comprises a bone and soft-tissue ring secured to the trunk by superior and inferior bony struts from which the upper extremity is suspended.

The ring is composed of the:
1. Glenoid process,
2. Coracoid process,
3. Coracoclavicular ligament,
4. Distal clavicle,
5. Acromioclavicular joint, and
6. Acromial process

The superior strut is the middle third of the clavicle while the inferior strut is the junction of the most lateral portion of the scapular body and the most medial portion of the glenoid neck.

The complex can be subdivided into three units:

1. The clavicular-acromioclavicular joint-acromial strut;
2. The three-process-scapular body junction; and
3. The clavicular-coracoclavicular ligamentous-coracoid (C-4) linkage.

Secondary support is supplied by the coracoacromial ligament.

The floating shoulder is depicted as a double disruption of the SSSC.

The most frequent form of the floating shoulder is the ipsilateral scapula neck and clavicle fracture.

Each of its components has its own individual actions:
1. It acts as a point of attachment for a variety of musculotendinous and ligamentous structures,
2. It permits limited, but significant movement to happen through the coracoclavicular ligament and the acromio-clavicular articulation, and
3. It maintains a normal stable relationship between the upper extremity and the axial skeleton.

It should be mentioned that the clavicle is the only bony connection between the upper extremity and the axial skeleton.

The scapula appear to 'hang' or to suspend from the clavicle by the coraco-clavicular ligaments and the acromio-clavicular joint.

There are many variations of floating shoulder present purely bony fractures or in combination with ligamentous disruption.

The injuries of the floating shoulder are produced by trauma from:
1. Motor vehicle or bike accidents
2. Falls
3. Being shot with a gun
4. Crushing of the shoulder

Factors that may raise the risk of this injury are:
1. Not wearing a seatbelt
2. Being around violent incidents

Symptoms of the floating shoulder may be:
1. Pain
2. Bruising
3. Swelling
4. Muscle spasms
5. The arm of the injured shoulder hanging lower than normal
6. Numbness or weakness

A high degree of suspicion for complex injury patterns is essential when assessing patients with injuries of the shoulder girdle.

Images may be taken of the shoulder.

Ipsilateral midshaft clavicle and glenoid neck fractures can normally be diagnosed radiologically with routine shoulder views (a true anteroposterior (AP) of the shoulder with the arm in neutral rotation, a axillary view of the glenohumeral joint, a lateral scapular view, and weight-bearing films).

Routine CT scans and three-dimensional reconstructions can help to depict the exact nature of the bony injury.

In principle the un-displaced or minimally displaced fracture can be treated non-operatively

Open Reduction Internal Fixation is the best treatment for displaced, comminuted clavicle fractures

TABLE OF CONTENT
Introduction...