Floating ShoulderS42.023A S42.113A

scapula anatomy

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)
  • Axillary
  • 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

  • Nonunion
  • Malunion
  • Infection
  • Neurovascular Injury
  • Pain
  • Stiffness

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