Shoulder corner joint dislocation
This term describes an “explosion” of the shoulder joint by direct or indirect force with resulting injury to the ligamentous apparatus. In comparison to a collarbone fracture, the cause of an acromioclavicular joint fracture is more likely to be direct violence, i.e. a fall on the shoulder. The pain lies further out in the shoulder or at the outer edge of the clavicle.
In addition, there is also swelling and bruising as well as a relieving posture (turning the arm towards the body and holding the bent arm by the healthy arm), since any kind of movement in the shoulder joint increases the pain here as well. A crunching when the shoulder joint is moved (crepitus sign) is also conceivable. Injury to the ligamentous apparatus can cause the collarbone to slip out of the acromioclavicular joint.
In this case, it protrudes upwards and creates a clearly visible bulge of skin over the inside of the shoulder. In this way, the “piano key phenomenon” typical of acromioclavicular joint fractures can be explained: If you press on the skin protrusion created by the displaced collarbone, the collarbone can be pushed down and then rises again as soon as you release it – just like a piano key. The diagnosis of an acromioclavicular joint dislocation is made by means of X-rays and, to assess the soft tissue and effusion, by means of an ultrasound examination. The latter offers the advantage that it also allows simultaneous assessment of the tendons of the muscles of the so-called rotator cuff that attach to the acromioclavicular joint, which are often also affected, especially in older patients.
Rib fracture
The main causes of rib fractures are direct violence in (bicycle) falls and traffic accidents. If more than two adjacent ribs are broken, this is called a serial rib fracture. Only in the case of a previous injury, for example in the context of osteoporosis, can rib fractures occur even without the occurrence of an accident, e.g. through a severe cough.
Rare but dangerous complications of a rib fracture are injuries to the lungs, such as the pneumothorax; however, in most cases the complication remains an isolated rib fracture. A typical symptom of a rib fracture is pain in the affected area, which increases during respiratory movements. Since coughing is a form of particularly strong breathing movements from a functional point of view, it causes particularly severe pain.
For reasons of protection, this circumstance can lead to superficial, ineffective breathing, which can impair the oxygen supply, especially in older patients. Since the rib fracture is a bony injury, the diagnosis is made primarily by x-rays.In order to assess whether the lung is also affected in the form of a pneumothorax, an X-ray can be taken in the exhalation position of the thorax. Finally, an ultrasound examination can be used to rule out concomitant injuries to the surrounding organs and vessels. In contrast to rib fractures, rib contusions do not destroy the structural unity of the bone. Symptoms and examination options largely coincide with those of rib fracture, so that a reliable distinction between the two injuries can only be made by means of an X-ray examination.
