Shoulder pain is a symptom commonly found in primary care, and it can be referred from elsewhere in the body, such as the neck, diaphragm, or even the heart. Shoulder problems share a number of clinical features. When the shoulder pain is assessed, it is important to look for any “red flags” that might indicate the need for an urgent approach.
A 14-year old male patient had a long-standing left shoulder pain. One year prior to presentation in his doctor’s office, he had a motorcycle accident and ended up being treated non-operatively.
He was submitted to 3 months of physical therapy and continued to complain. His left shoulder showed signs of lateral scapular winging. The initial management at the time of his injury was focused on the proximal humerus fracture and the persistent pain was attributed to the left coracoid nonunion.
The patient received a brachial plexus block and general anesthesia, the coracoid was exposed and the angle for insertion was measured on a pre-operative CT and replicated in the OR using fluoroscopy.
A system that could help with the pre-operative planning is PeekMed. PeekMed offers the possibility of inserting templates of the materials to be used in the surgery in addition to the pre-operative measurements. This provides a total overview of the surgery, which improves the accuracy of the team.
The patient used a sling for one-week post-operatively that allowed no motion of the shoulder or elbow.
Fractures of the coracoid process are associated with traumatic shoulder dislocation and are even rarer in pediatric patients. They can be treated non-operatively, but fractures that are unstable or persistently painful should be treated with open reduction and internal fixation.
Athletes or heavy manual laborers are the most likely to require an operative fixation for this type of fracture.