Review of Rare Floating Shoulder InjuryIn this article, two orthopedic surgeons from Cleveland, Ohio review the anatomy, biomechanics, diagnosis, and treatment of the floating shoulder. If the bones are fractured but the ligaments are okay, then sometimes the injury can heal on its own.
But without the ligaments for stability, the weight of the arm along with gravity and muscle forces can pull the socket forward. When this happens, the rotator cuff muscles around the shoulder can no longer function normally. The shoulder may droop and pinch soft tissues or nerves causing pain and failure to heal.
Most floating shoulder injuries are caused by severe trauma from a fall or car accident. X-rays may help in making the diagnosis. Sometimes special views such as the Stryker notch. or special measures such as the glenopolar angle (GPA) are needed to see ligament damage. Three-dimensional (3-D) CT scan may be needed, too.
How to treat a floating shoulder remains a matter of debate among surgeons. Some favor nonsurgical treatment. It's not invasive and there are no extra complications. Others advise surgery to give the patient pain relief and improve function. Surgery may be the only way to stabilize the shoulder. The authors review arguments for both treatment methods.
They advise nonsurgical care for patients with small fractures and no (or minimal) ligament damage. Surgery should be used for patients with fractures that are separated quite a bit. Each patient must be viewed on a case-by-case basis. Most of the time surgery isn't needed. More studies are needed to compare which treatment works best, but this injury is rare so a definite answer about the best treatment may not be coming soon.
Michael J. DeFranco, MD, and Brendan M. Patterson, MD. The Floating Shoulder. In Journal of the American Academy of Orthopaedic Surgeons. August 2006. Vol. 14. No. 8. Pp. 499-509.
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