Shoulder Injuries, Term Paper Example

Abstract

The medical field is shaped by diverse clinical aspects. Some of these aspects are linked to either anatomical or physiological treatment. It is from such observation we find the rule of radiology a foremost line of treatment and diagnosis within the realm of medical fields.

Introduction

The pectoral strap or the shoulder girdle is made of three bones that is to say; clavicle, scapula, and the proximal humerus. In addition to this comprise acromioclavicular and glenohumeral joint. These bones are interconnected in that they tie the upper edge with the thorax and are seriously correlated to the harrowing injuries such as dislocations as well as fractures in any given person (Gray, 2009).  Nonetheless, to establish the nature and extent of the harm on the specific shoulder diagnostic radiology is required for it plays a critical role in determining either the affected part or the source of the injury.

Radiology is one of the major branches of medical science concerned with medical imaging. This may comprise devices as X-ray machines or other radiation interrelated appliances. Radiology also encompasses processes that do not necessitate radiation, such as ultrasound or MRI. As a major medical area this discipline touches on two central subfields namely diagnostic and therapeutic radiology. Diagnostic radiology is concerned with the dynamics of diverse imaging aspects in diagnosis of diseases. This branch is also divided into various specialties. On the other hand, therapeutic radiology is more employed in treating such ailments as cancer through a form of unique treatment classified as radiation therapy.

Case study

Generally, diverse modalities are employed in radiography and they involve plain radiography, magnetic resonance imaging (MRI), nuclear imaging techniques, computed tomography (CT), and ultrasound. However, these modalities do have their own unique strengths and weaknesses which determine their significance in the course of diagnosis.

From such observation it ought to be noted that shoulder strains is one of the most common feature allied to the shoulder injuries. These injuries encompass injuries caused by falls onto the shoulder and this may either touch or fracture the clavicle (collar bone) or equally fracture the scapula (shoulder blade). Basically, the shoulder is a composition of three bones namely;

Scapula, clavicle, and the humerus (arm bone). These shoulder bones are boded by supple tissues such as the muscles, tendons, joint capsules and ligaments, to form a suitable domain for the arm to function. Hence, some of the joint found within the shoulder include; Glenohumeral joint, Acromioclavicular joint, and Sternoclavicular joint.

The shoulder sustains one of the key articulations, that is, the relationship concerning scapula and the chest wall. All in all, the shoulder is commonly covered by a number of layers which are classified as soft tissues. The uppermost layer is known as deltoid muscle and this is the layer that gives the shoulder its unique rounded appearance. This layer is essential in that it helps to bring the arm overhead.

Types of shoulder injuries

Shoulder injuries are many and diversified. Fractures, for instance, are broken bones, while dislocations take place or occur when the alternating bones fail to line up. Hence, dislocations entail three core joints, that is: a dislocation of acromioclavicular joint or as commonly known as separated shoulder. Another common injury involves the dislocation of sternoclavicular joint and this regards the interruption of the link touching the clavicle and the sternum (breastbone). The other shoulder related injury involves the dislocation of the glenohumeral joint. This takes place when the joint is dislodged and tends to lean inwardly or outwardly.

Pathology for those signs and symptoms

The typical conditions and symptoms linked to shoulder injuries or strains include; tissues tears, rheumatoid arthritis, degeneratives circumstances as well as avascular necrosis among other symptoms (Mehta,et al,2006).Direct blow to the clavicle or the proximal humerus may result in fracture and this could as a consequence of direct collision, accident or fall. However, scapula fractures are more correlated with injuries of the chest.

A-clavicle fractures are commonly defined by location and this is done with clavicle being divided into solid thirds: distal, proximal and the middle. B denotes a scapular fracture. As is in the above diagram.

Thus, shoulder trauma can be said to be caused by three elements that is, shoulder dislocation, shoulder separation, and fractures.

Etiology and risk factors

From time to time doctors do use diagnostic radiology in examining body in such way that they cannot do so from the outside observation. Diagnostic radiology involves the use of diverse electronic procedures as well as medical equipments to generate images that expose or reveal what is wrong or is happening inside the patient’s body. Though, a number of the diagnostic tests have been established to be uncomfortable, majority of them are known to be painless and equally noninvasive. More so, the device the doctor opts to use depends with the nature of the patient needs. Some of the commonly preferred tests include MRI, CT, mammography, as well as ultrasound. These tests are carried out by radiologists. One of the basic significance of diagnostic radiology lies in its use in detecting any anomalies in the body.

By carrying out molecular imaging doctors are empowered to examine the body from a cellular level and equally pick out the disease before the diseases reaches a critical level. These inclusive tests expose the structures and the function of such features as the shoulder, chest as well as the function of the heart allowing the doctor to detect the abnormalities in the manner they function. One of the most typical diagnostic imaging or radiography tests entails digital mammography. This examination does allow the electronic image to be generated in order to determine or reveal existence of any variations regarding the normal and abnormal human tissues. Thus, diagnostic radiography is essential in detecting any changes in the human bone structures.

Analysis and treatment

Most of these anomalies are diagnosed by using x-rays as well as carrying out physical examination of the affection area. And this may sometime entail additional imaging procedures such as CT which is necessary. In essence, diagnostic radiology and in particular the plain radiology is the most popular choice in regard to examination of upper extremity.

And this is typically illustrated by the presence of acute shoulder trauma in the upper area of the body. This region harbors the shoulder, wrist, humerus and the forearm which forms a critical diagnostic pattern in detecting any acute fracture.

Interventions with scientific rationales

Basically, such imaging procedures as CT, MRI, and ultrasound are not commonly exploited in the course of handling acute trauma, but are essential in dealing with the soft tissue pathology^. When dealing with the upper extremity and in particular the shoulder, it would be essential to point out that the major pointer for plain radiography in regard to the shoulder is acute trauma . This is due to the fact that through radiography a number of abnormalities such as fractures of the scapula, humerus, scapula as well as the shoulder dislocation such as glenohumeral or shoulder separation (acromioclavicular) could be detected

In such a situation most patients may present mixed signs of sub-acute, chronic, or non-traumatic pain, the use of plain radiographic films in such a situation is commonly insignificant. However, where chronic and non traumatic pain is suspected, plain radiographic film is employed to expose if the patient requires either prereduction or postreduction radiography or both.

Diverse studies have established that plain radiographic films used in diagnostic radiology do not show or expose any pathological findings. However, in such a situation most doctors opts to utilize MRI in order to detect any injuries correlated to ligaments such as the rotor cuff which are rarely indicated in the normal setting.

Some of the shoulder injury regards the fracture of the humerus. Humerus as is seen from the following image is the upper segment of the bone linking the shoulder with the elbow. Basically, their exists three major variations of the fractures that can be detected from this diagram;

From this diagram it is evident that there are a number of features allied to the defects spotted on the bone. These include;

• Fractures allied to the upper end of the bone-this anomaly touches both the head as well as the neck of the bone
• Fractures center piece of the bone.
• Fractures tied to the elbow as well as the bone and are commonly referred as supra-condylar fractures. This is due to the fact that they typically occur at the upper or above the condyles. These features are highly likely to affect the juveniles more than adults.

The initial two commonly comes as a consequence of express trauma relating to humerus, that is, a heavy fall or equally a direct collision with a blunt or weighty object. Shaft fractures specifically occur where bending forces are exerted. While supracondylar fractures are collated to the upper transfer of force which breaks affects the lower humerus and this forces the supracondylar to be affected or break.  Also these observations touch on the upper humeral fractures. It ought to be noted that these fractures do persistently affect the neck of the concerned bone ⁹. However, the most essential aspect is to determine whether the fracture concerns dislocation, or is equally in stable position or not. This is due to the fact hat most stable fractures do not require any serious radiography. Also surgery is not commonly needed in such a situation. More or less displaced fractures do in some cases call for reduction that is, pulling under the anesthetic so as to make the bone fragments to be put together.

Fractures of the Shaft of the Humerus

Exploring the core aspects of diagnostic radiology, it is widely accepted that these injuries are quite painful.

And in some instances they do tend to cause severe damages to the radial nerve. However conservative medication is known to be effectual, but it cannot guarantee that the bones could be fully restored to their normal position.

Explanations

Basically, radiographic examination as is allied to the shoulder trauma happens to be one of the most occurring and frequently performed within the medical divisions.

The key objective being to examine the trauma patients, but in some cases it has been established to be providing unreliable and incorrect outcomes. Hence, a radiographic study allied to the shoulder thus requires two or more radiographs and this would entail having dissimilar projections, that is, fore Anteroposterior perspective or view as well as extra projections placed at right angles to each other. The shoulder radiograph of the patient investigated for acute trauma do reveals that the former examination lacked adequate both lateral and oblique view in unear6hing the shoulder fractures and this was due to the fact that they lacked anteroposterior perspective (Mehta,et al,2006). It ought to be noted that antero-posterior view is the most effective projection in regard to diagnostic radiography, the reason this is seen to be can be allied to the fact that it helped in detecting over 90 % of the suspected injuries.

Diagnostic tests

However, according to the radiographic images acquired it is evident that both the oblique apical as well as the lateral views were not fully sensitive as is with the antero-posterior view which aided in detecting 80% and 75% of the injuries. The glenohumeral  dislocations whether with either the fracture including the clavicular fractures were  basically exposed through the oblique apical approach, while in the same manner fractures linked to the body as well as the coracoid procedures of the scapula were highly exposed by the lateral view (MedlinePlus,n.d)

This demonstrates that for the diagnostic radiology to be of great value to the patient the radiologist may opt to work hand in hand with the orthopedist so as to make the right decisions in regard to the projections anticipated to be used for each and every patient on the basis of physical examination.

Nursing diagnosis and intervention for  shoulder injuries

The head back experiences dystocia recoil against perineum as a result of impaction in anterior shoulder at the back of symphysis pubis. Nurses are also guided by red flags which symptoms that indicate serious pathology accompanied by an urgent requirement for referral to suitably qualified specialist. Nursing diagnosis should also incorporate imaging studies which aid in the confirmation of diagnosis. This is achieved by use of ultrasound and magnetic resonance types of imaging. These are the advanced tests that indicate the actual location of injury. The nurses also subject the victim to stresses and positions aimed at eliciting the conspicuous pain signs. In addition to the use of X-rays and MRI, arthrogen is sometimes applied in which case a dye is applied to the joint to clearly show the position of the tear.

To avoid a situation of ambiguity in diagnosis, it is vital that the nurses consider physical therapy, rest as well as icing as preliminary intervention measures. treatment options that apply non-surgical techniques such as using sling, steroid injections and anti-inflammatory medications are also recommended. Failure of these approaches to work may necessitate further diagnosis and examination.

Nurses should also consider the following interventions:

• Rotation of fetal shoulder to oblique
• Alteration of the pelvic angle
• Application of suprapubic pressure
• The patient may be subjected to specific exercises which facilitate strengthening of the muscles around affected joints consequently leading to pain relief.
• Muscles along with tendons in the region of affected joints may be stretched and this alleviates the shoulder pain
• Rest is an important intervention once shoulder pain has been diagnosed which allows subsiding of pain arising from swelling or bruising resulting to shoulder injury
• Cortisone injections may also be administered

Risk factors

Despite the advantages of diagnostic radiology there are also risk factors which are to be considered in the course of dealing with the aspects of imaging. This is due to the fact that unlike any other form of diagnosis radiology id predominantly anchored in the use of radiation, and this indicates that risks linked to exposure do exist. However, the risk of acquiring cancer due to radiology is predominantly low.

Lab value

• blood count test is within normal ranges of WBC: 5.7
• hemoglobin: 13.4
• hematocrit: 41.2
• RBC count: 4.6,
• Platelet count: 320.
• Chemistry levels of glucose: 89
• iron: 102
• sodium: 139
• potassium: 4.0
• chloride: 101 , co2:27
• BUN: 14
• creatinine: 0.6
• calcium: 9.4 are within normal ranges and fecal occult blood testing is negative.

Limitations

Though acute shoulder injuries may be adequately and highly assessed through the use of a standard or average two-view shoulder procedure, posterior dislocation can be subtle or in the same manner hard to detect or diagnose. If posterior dislocation is detected or suspected as per the available examination, physical or the average radiographic as well as extra specialized views which may include both axillary’s as well as oblique view becomes essential. All in all, most of the radiographic views can be adequately acquired even where the concerned patient has a limited or restricted mobility. However, the axillary’s view has been established to require diverse degree of abduction and this may prove to be difficult in some instances.

Conclusion

Diagnostic radiography is paramount in regard to the medical profession. Despite the diverse challenges which have over the time been associated with this practice, diagnostic radiography have proved to be effective in as far as dealing with the trauma of the shoulder is concerned. It ought to be noted that by applying diverse imaging techniques doctors have over the time managed to examine or investigate any fractures or injuries affecting the entire shoulder. According to the available medical evidence it is highly recommended that shoulder dislocations do not necessarily need to be x-rayed before they are put back into place.  Radiology does provide a number of benefits for both patients and physicians (Banh,et al, 2011). It ought to be noted that general radiology such as x-ray do allow the doctors to examine the bones surrounding specific body parts such as the shoulder dislocations in order to make the suitable diagnosis. Also radiology helps in that it allows the concerned doctors to monitor any changes in regard to the changes in injury and equally make the right decision concerning the best way to follow.

Works cited

Banh, K and Hendley, G. Plain Radiography. 2011, November 23. http://assets.cambridge.org/97805218/70542/excerpt/9780521870542_excerpt.pdf

Daffner, R.(2007). Clinical Radiology: The essentials. Baltimore, MD: Lippincott Williams & Wilkins.

Gray,H.(2009). Fundamentals of computerized tomography: Image reconstruction from projection, 2nd edition. Springer.

Kaplan, P. and Helms, A.(2006).  Musculoskeletal MRI, Saunders.

Medline Plus. Diagnostic Imaging. 2011 November 23. http://www.nlm.nih.gov/medlineplus/diagnosticimaging.html

Mehta, A.(2006). . Radiology. Totowa, NJ. Humana Press.