PubMed · 7171901
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J B King. 1982. Fractures. The upper limb-1.. https://pubmed.ncbi.nlm.nih.gov/7171901/
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In two patients with shoulder complaints, a man aged 56 years and a woman aged 43, the function of the shoulder girdle (structures of the cervical spine, the upper thoracic spine and the upper ribs) played an important role. A simple classification of shoulder complaints is presented in which the influence of the shoulder girdle is recognized: (a) synovial disorder: complaints originating from the structures of the glenohumeral joint, the subacromial space, the acromioclavicular joint or combinations of these, (b) shoulder girdle disorder: the complaints are caused by functional problems in the structures of the shoulder girdle, (c) combination disorder: both a synovial disorder and a functional disorder of the structures of the shoulder girdle are causing the complaints, making it impossible to determine which structure is the primary cause. Considering the limited therapeutic choices (at first nonsteroidal antiinflammatory drugs, followed in case of persistent complaints by injections of analgesics and corticosteroids for synovial complaints, or manipulative therapy for shoulder girdle complaints), a more detailed classification is not needed to determine a successful therapeutic strategy.
Family physicians often are required to evaluate patients who present with acute skeletal trauma. The first of this two-part series discusses the features and evaluation of some commonly missed fractures and dislocations of the upper limb, excluding the hand. Dislocations of the sternoclavicular joint are infrequent and often missed. Clavicular fractures in adults usually are not hard to diagnose. Acromioclavicular joint dislocations represent about 10 percent of all dislocation injuries to the shoulder girdle. Forty percent of all dislocations occur at the glenohumeral joint. Scapular fractures are often a result of significant force. Multiple views should be obtained in adults with a suspected fracture of the elbow. Complications in fractures of the wrist are strongly related to the location of the fracture.