synonyms: floating shoulder, superior shoulder suspensory complex
Floating Shoulder ICD-9
- 810.01 Clavicle Fracture
- 811.00 (fracture of scapula, upper end, unspecifiec part, closed)
Floating Shoulder Etiology / Epidemiology / Natural History
- Historically floating shoulder designated clavicle shaft fracture with associated ipsilateral scapular neck fracture, however recent biomechanical studies have demonstrated that a true floating shoulder also requires disruption of the coracoacromial and acromioclavicular ligaments (Williams GR Jr, JBJS 2001;83A:1182).
Floating Shoulder Anatomy
- Superior shoulder suspensory comples = glenoid, coracoid, distal clavicle, acromion, and coracoclavicular and AC ligaments. (Goss TP, JOT 1993;7:99).
- Ipsilateral fractures of the scapular neck and the clavicular shaft do not produce a floating shoulder without additional disruption of the coracoacromial and acromioclavicular capsular ligaments. (Williams GR Jr, JBJS 2001;83A:1182).
- See also Shoulder Anatomy.
Floating Shoulder Clinical Evaluation
- ATLS resuscitation. These are typically high enegery injuries, assessment should begins with the A,B,C's.
- C/O shoulder pain after trauma.
- Evaluate for tenderness, ecchymosis, soft tissue injury.
- Document axillary, median, ulnar, radial nerve function and radial pulse.
Floating Shoulder Xray / Diagnositc Tests
- A/P view of clavicle and 30° cephalic tilt view of clavicle.
- A/P and Scapular-Y view of shoulder
- Apical oblique (Grashe with 20 cephalad)
- Abduction Lordotic (after ORIF)
- Serendipity view (helps with A/P displacement)
- Zanca 15 degree apical oblique (AC joint)
- Consider chest xray (including both clavicles) if there is significant deformity (shortening) or if concerned for pneumothorax or rib fx's.
- CT with 3-D reconstruction generally indicated to fully assess fracture patterns
Floating Shoulder Classification / Treatment
- Ipsilateral Glenoid and clavicle fracture without caudal displacement (AC ligament injury): non-operative treatment (vanNoort A, JBJS 2001;83Br;795).
- Floating shoulder with caudal displacement: ORIF of the clavicle +/- glenoid neck.
Floating Shoulder Associated Injuries / Differential Diagnosis
Floating Shoulder Complications
- Neurovascular Injury
Floating Shoulder Follow-up Care
- Post-op: sling for comfort, no overhead motion. Immediate pendelum ROM exercises.
- 10-14 Days: Wound check, sutures removed. Start PT for gentle ROM exercises. No resistive exercises/activities. Sling.
- 6 weeks: Xrays, if union is evident begin strengthening and resistive exercises. No contant athletics.
- 3 months: Repeat xrays. If pt is painfree and union is obvious pt may return to sport. If no signs of union, consider bone stimulator, see Nonunion.
- Shoulder Outcome Measures.
Floating Shoulder Review References
- Rockwood and Green's Fractures in Adults 6th ed, 2006
- OKU - Shoulder and Elbow 2nd ed, 2002