Anterior shoulder dislocation - Revision history

Rossdonaldson1: /* Complications */

2024-02-28T19:45:52Z

Complications

← Older revision		Revision as of 19:45, 28 February 2024
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	==Complications==		==Complications==
			[[File:Shoulder dislocation with Bankart and Hill-Sachs lesion, before and after reduction.jpg\|thumb\|Anterior shoulder dislocation post reduction showing classic complicatoins. The bony Bankart lesion is new, as evidenced by lack of cortex on the superior part of the fragment, and is presumed to be caused by glenohumeral ligaments pulling the humerus towards the glenoid as the shoulder dislocates, causing a fracture even without significant external forces. The Hill-Sachs lesion may be old, since the patient had previous shoulder dislocation.]]
	*Recurrent dislocation		*Recurrent dislocation
	**39% risk of recurrence after traumatic dislocation<ref>Olds, M., Ellis, R., Donaldson, K., Parmar, P., and Kersten, P. (2015) Risk factors which predispose first-time traumatic anterior shoulder dislocations to recurrent instability in adults: A systematic review and meta-analysis. British Journal of Sports Medicine, 49(14).</ref>		**39% risk of recurrence after traumatic dislocation<ref>Olds, M., Ellis, R., Donaldson, K., Parmar, P., and Kersten, P. (2015) Risk factors which predispose first-time traumatic anterior shoulder dislocations to recurrent instability in adults: A systematic review and meta-analysis. British Journal of Sports Medicine, 49(14).</ref>

Patricklin at 01:34, 22 February 2024

2024-02-22T01:34:59Z

← Older revision		Revision as of 01:34, 22 February 2024
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	[[File:Shoulder_joint_back-en.png\|thumb\|Shoulder anatomy, anterior.]]		[[File:Shoulder_joint_back-en.png\|thumb\|Shoulder anatomy, anterior.]]
	[[File:Shoulder joint back 05r4v.png\|thumb\|Shoulder anatomy, posterior.]]		[[File:Shoulder joint back 05r4v.png\|thumb\|Shoulder anatomy, posterior.]]
	*Shoulder dislocations account for 50% of all major joint dislocations, 90-98% are anterior<ref name="Guler">Guler O, Ekinci S, Akyildiz F, et al. Comparison of four different reduction methods for anterior dislocation of the shoulder. Journal of Orthopaedic Surgery and Research. 2015;10:80. doi:10.1186/s13018-015-0226-4.</ref>		*Shoulder dislocations account for 50% of all major joint dislocations; 90-98% are anterior<ref name="Guler">Guler O, Ekinci S, Akyildiz F, et al. Comparison of four different reduction methods for anterior dislocation of the shoulder. Journal of Orthopaedic Surgery and Research. 2015;10:80. doi:10.1186/s13018-015-0226-4.</ref>
	*Majority of anterior shoulder dislocations are due to trauma		*Majority of anterior shoulder dislocations are due to trauma, such as FOOSH incident or motor vehicle accident
	*Important to rule out [[Axillary neuropathy\|~~axillary~~ nerve injury]]		*Important to rule out neurological injury; it is critical to assess pre- and post-reduction neuro status
	**Most common finding is 'military patch' (deltoid) anesthesia		**[[Axillary neuropathy\|Axillary nerve injury]] is common and may be present in 42% of anterior dislocations<ref>Pak T, Kim AM. Anterior Glenohumeral Joint Dislocation. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing</ref>
			***Most common finding is 'military patch' (deltoid) anesthesia
			**Brachial plexus injury is possible, leading to weak/absent elbow flexion (C5-6), wrist extension (C6), or finger abduction/adduction (C8-T1)<ref>Kauta N, Porter J, Jusabani MA, Swanepoel S. First-time traumatic anterior shoulder dislocation: Approach for the primary health care physician. S Afr Fam Pract (2004). 2023 Jun 26;65(1):e1-e7. doi: 10.4102/safp.v65i1.5744. PMID: 37427774; PMCID: PMC10331046.</ref>
			**Most nerve injuries are due to traction/neuropraxia, and true nerve transection is rare
			*Arterial injury, such as axillary artery injury, is rare but also important to rule out<ref>Julià J, Lozano P, Gomez F, Corominas C. Traumatic pseudoaneurysm of the axillary artery following anterior dislocation of the shoulder. Case report. J Cardiovasc Surg (Torino). 1998 Apr;39(2):167-9. PMID: 9638999.</ref>

	{{Shoulder dislocation types}}		{{Shoulder dislocation types}}
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	==Clinical Features==		==Clinical Features==
	*Pain		*Pain
	*Arm maintained in abduction		*Arm maintained in abduction and external rotation
	*Shoulder appears 'squared off' (loss of normal rounded appearance with stretching of the deltoid muscle)		*Shoulder appears 'squared off' (loss of normal rounded appearance with stretching of the deltoid muscle)
	*Difficulty touching affected arm to contralateral shoulder due to pain		*Difficulty touching affected arm to contralateral shoulder due to pain
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	[[File:Luxation epaule.png\|thumb\|Anterior dislocation with fracture]]		[[File:Luxation epaule.png\|thumb\|Anterior dislocation with fracture]]
	*Plain film X-ray of shoulder		*Plain film X-ray of shoulder
	**At least 3 views		**At least 3 views, which include AP, orthogonal, and modified axillary view
	***Axillary lateral or scapular "Y" view can help distinguish between anterior and posterior dislocation		***Axillary lateral or scapular "Y" view can help distinguish between anterior and posterior dislocation
	**Rule out associated ~~fracture~~		**Rule out associated fractures, such as Hill Sach's lesion or Bankart lesion
	*May forego imaging if:		*May forego imaging if:
	**Age <40		**Age <40
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	==Disposition==		==Disposition==
	*Discharge after successful reduction		*Discharge after successful reduction and subsequent confirmatory XR
	**Maintain [[sling +/- swath]] or shoulder immobilizer (shoulder in adduction and internal rotation) until seen in follow-up by orthopedic surgery		**Maintain [[sling +/- swath]] or shoulder immobilizer (shoulder in adduction and internal rotation) until seen in follow-up by orthopedic surgery within 1 week
			**After 1-3 weeks of shoulder immobilization, if pain-free, can slowly return to activity as tolerated<ref>Hasebroock AW, Brinkman J, Foster L, Bowens JP. Management of primary anterior shoulder dislocations: a narrative review. Sports Med Open. 2019 Jul 11;5(1):31. doi: 10.1186/s40798-019-0203-2. PMID: 31297678; PMCID: PMC6624218.</ref>
			*Orthopedic consult indicated for associated humeral fracture, subacute dislocation, or failure to reduce by the emergency physician

	==Complications==		==Complications==
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	****Occupation		****Occupation
	*Bony injuries		*Bony injuries
	**Hill-Sachs ~~lession~~		**Hill-Sachs lesion
	***Compression fracture of humeral head		***Compression fracture of humeral head
	***40% of cases		***40% of cases

Rossdonaldson1: /* Disposition */

2020-06-22T20:11:16Z

Disposition

← Older revision		Revision as of 20:11, 22 June 2020
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	==Disposition==		==Disposition==
	*Discharge after successful reduction		*Discharge after successful reduction
	**Maintain [[sling +/- swath]] or shoulder immobilizer until seen in follow-up by orthopedic surgery		**Maintain [[sling +/- swath]] or shoulder immobilizer (shoulder in adduction and internal rotation) until seen in follow-up by orthopedic surgery
	**Refer all first-time dislocations for outpatient orthopedic follow up
	**Recurrent dislocators who have not undergone repair benefit from outpatient orthopedic referral for consideration of rotator cuff repair (traumatic mechanism) or capsular plication (atraumatic)

	==Complications==		==Complications==

Rossdonaldson1: /* Management */

2020-06-22T20:09:02Z

Management

← Older revision		Revision as of 20:09, 22 June 2020
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	*[[Procedural sedation]] often required		*[[Procedural sedation]] often required
	**Consider intra-articular lidocaine (10-20mL) as alternative to procedural sedation<ref>Intra-articular lignocaine versus intravenous analgesia with or without sedation for manual reduction of acute anterior shoulder dislocation in adults (Review) Cochrane Database Syst Rev. 2011 Apr 13;(4):CD004919 [http://www.update-software.com/BCP/WileyPDF/EN/CD004919.pdf full text]</ref>		**Consider intra-articular lidocaine (10-20mL) as alternative to procedural sedation<ref>Intra-articular lignocaine versus intravenous analgesia with or without sedation for manual reduction of acute anterior shoulder dislocation in adults (Review) Cochrane Database Syst Rev. 2011 Apr 13;(4):CD004919 [http://www.update-software.com/BCP/WileyPDF/EN/CD004919.pdf full text]</ref>
	*After reduction, apply immobilizer with shoulder in adduction and internal rotation

	===Reduction Techniques===		===Reduction Techniques===
	====Techniques that generally do not require sedation====		====Techniques that generally do not require sedation====

	*FARES (Fast, Reliable, and Safe) Method:		*FARES (Fast, Reliable, and Safe) Method:
	#Place the patient supine or prone		#Place the patient supine or prone

Rossdonaldson1: /* Disposition */

2020-06-22T20:08:41Z

Disposition

← Older revision		Revision as of 20:08, 22 June 2020
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	==Disposition==		==Disposition==
	*Discharge after successful reduction		*Discharge after successful reduction
	*Maintain [[sling +/- swath]] or shoulder immobilizer until seen in follow-up by orthopedic surgery		**Maintain [[sling +/- swath]] or shoulder immobilizer until seen in follow-up by orthopedic surgery
			**Refer all first-time dislocations for outpatient orthopedic follow up
			**Recurrent dislocators who have not undergone repair benefit from outpatient orthopedic referral for consideration of rotator cuff repair (traumatic mechanism) or capsular plication (atraumatic)

	==Complications==		==Complications==

Rossdonaldson1: /* Management */

2020-06-22T20:07:56Z

Management

← Older revision		Revision as of 20:07, 22 June 2020
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	**Consider intra-articular lidocaine (10-20mL) as alternative to procedural sedation<ref>Intra-articular lignocaine versus intravenous analgesia with or without sedation for manual reduction of acute anterior shoulder dislocation in adults (Review) Cochrane Database Syst Rev. 2011 Apr 13;(4):CD004919 [http://www.update-software.com/BCP/WileyPDF/EN/CD004919.pdf full text]</ref>		**Consider intra-articular lidocaine (10-20mL) as alternative to procedural sedation<ref>Intra-articular lignocaine versus intravenous analgesia with or without sedation for manual reduction of acute anterior shoulder dislocation in adults (Review) Cochrane Database Syst Rev. 2011 Apr 13;(4):CD004919 [http://www.update-software.com/BCP/WileyPDF/EN/CD004919.pdf full text]</ref>
	*After reduction, apply immobilizer with shoulder in adduction and internal rotation		*After reduction, apply immobilizer with shoulder in adduction and internal rotation
	*Refer all first-time dislocations for outpatient orthopedic follow up
	*Recurrent dislocators who have not undergone repair benefit from outpatient orthopedic referral for consideration of rotator cuff repair (traumatic mechanism) or capsular plication (atraumatic)

	===Reduction Techniques===		===Reduction Techniques===

	====Techniques that generally do not require sedation====		====Techniques that generally do not require sedation====

Rossdonaldson1: /* See Also */

2020-06-22T20:06:52Z

Rossdonaldson1: /* Complications */

2020-06-16T18:39:48Z

Complications

← Older revision		Revision as of 18:39, 16 June 2020
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	**Bony Bankart lesion<ref>https://radiopaedia.org/articles/bankart-lesion</ref>		**Bony Bankart lesion<ref>https://radiopaedia.org/articles/bankart-lesion</ref>
	***Fracture of anteroinferior glenoid rim		***Fracture of anteroinferior glenoid rim
	*Axillary nerve injury		*[[Axillary nerve injury]]
	**Up to 14% of cases		**Up to 14% of cases
	**Usually self-resolves		**Usually self-resolves

Rossdonaldson1: /* Disposition */

2020-06-16T18:37:43Z

Disposition

← Older revision		Revision as of 18:37, 16 June 2020
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	==Disposition==		==Disposition==
	*Discharge after successful reduction		*Discharge after successful reduction
	*Maintain in shoulder immobilizer until seen in follow-up by orthopedic surgery		*Maintain [[sling +/- swath]] or shoulder immobilizer until seen in follow-up by orthopedic surgery

	==Complications==		==Complications==

Rossdonaldson1: /* Imaging */

2020-06-16T18:36:34Z

Imaging

← Older revision		Revision as of 18:36, 16 June 2020
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	[[File:Luxation epaule.png\|thumb\|Anterior dislocation with fracture]]		[[File:Luxation epaule.png\|thumb\|Anterior dislocation with fracture]]
	*Plain film X-ray of shoulder		*Plain film X-ray of shoulder
	**At least 2 views		**At least 3 views
	***Axillary lateral or scapular "Y" view can help distinguish between anterior and posterior dislocation		***Axillary lateral or scapular "Y" view can help distinguish between anterior and posterior dislocation
	**Rule out associated fracture		**Rule out associated fracture

← Older revision		Revision as of 20:06, 22 June 2020
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	==See Also==		==See Also==
	*Shoulder dislocation		*[[Shoulder dislocation]]

	==External Links==		==External Links==