Shoulder Dislocation
HUSNA NAJIHAH BINTI DZULKARNAIN1213828
Shoulder dislocation
• An emergency!• Failure to reduce a dislocated shoulder
successfully within the first 24 hours carries the risk that it will be impossible to achieve a stable closed reduction.
• Neurovascular injury can occur.
Types of shoulder dislocation
Anterior dislocation (>95 %)Posterior dislocation (2-4 %)
Inferior dislocation (Luxatio Erecta) (<1 %)
Anterior dislocation
Mechanism of injury:• Abduction+ external
rotation + extension injury
• Direct blow from the posterior aspect of the shoulder.
• A fall from an outstretched hand
Posterior Dislocation
– Fall on to the flexed, adducted arm
– A direct blow on the front of the shoulder
– Can occur during a fit or convulsion or with an electric shock
Associated Injuries
Anterior Dislocation
• Bankart lesion
• Hill Sach lesion
Posterior Dislocation
• Reverse Bankart
• Reverse Hill Sach lesion
History
Complain of:1) Pain over shoulder area2) Inability to move the
arm from its current position
3) Numbness of the arm.4) Visibly displaced
shoulder
+ Mechanism of injury
Physical Examination
Investigation
• X-ray findings:
AP x-ray • overlapping shadows of the
humeral head and glenoid fossa - the head is below and medial to the socket
Lateral x-ray• humeral head out of line with
the socket.
AP view
Axillary ViewEmpty glenoid sign
Posterior dislocation
AP viewElectric light bulb head
Complication
EARLY
LATE
• Rotator Cuff Tear (38 %)
• Axillary nerve injury (12%)
• Axillary artery (1-2%)• Fracture-dislocation
• Shoulder Stiffness• Unreduced
Dislocation• Recurrent Dislocation
Management
Closed reduction – sedation or general anaesthesia
If failed: open reduction
Surgical procedures for associated injuries (Bankart operation etc).
Hippocratic Maneuver- traction and countertraction
1. Patient supine on bed2. Gently increasing
longitudinal traction is applied to the arm with shoulder in slight abduction
3. Assistant applies firm countertraction to the body
Kotcher’s Method - no traction
1. The elbow is bent to 90⁰ and held close to the body
2.The arm is slowly rotated 75⁰ laterally
3.The point of the elbow is lifted forwards
4.Finally, the arm is rotated medially
http://emedicine.medscape.com/article/109130-technique#c4
Stimson’s Technique – Gravitational traction
1.Patient is left prone with the arm hanging over the side of the bed.
2.10 – 15 lb weight suspended from wrist
3.With muscle relaxation secondary to analgesia, and gravitational traction, the shoulder may reduce within 15 or 20 minutes.
Management for Post-reduction
• Post reduction x-ray for confirmation and exclude fracture
• Patient fully awake, test for active abduction (exclude axillary nerve and rotator cuff tear)
• Also test for other nerves (median, radial, ulnar) and vessels injury (pulse).
• Immobilization by using arm sling for about 3 weeks (<30 years old) or a week (>30 years old) .
• Plan for rehabilitation
Surgery
• Indication:– Failed closed reduction.– Fracture of greater tuberosity that is displaced
greater than 1cm postreduction.– Glenoid rim fractures that are displaced greater
than 5mm.
References
• Harries M., Williams C.,Stanish W.D., Michelle L.J, Oxford Textbook of
Sports Medicine,1998, Oxford Medical Publication.• Simon R.R., Koenigsknetch S.J., Emergency Orthopedics of the
Extremities, 2001, McGraw Hill.• Medscape
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