Inferior shoulder dislocation: Difference between revisions
No edit summary |
No edit summary |
||
| (8 intermediate revisions by one other user not shown) | |||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
[[File:Gray326.png|thumb|Left shoulder and acromioclavicular joints with ligaments.]] | |||
[[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.]] | ||
| Line 8: | Line 9: | ||
**Rarely caused by high-energy force applied to shoulder from above<ref name="Grate">Grate I Jr. Luxatio erecta: a rarely seen, but often missed shoulder dislocation. Am J Emerg Med. 2000 May;18(3):317-21.</ref> | **Rarely caused by high-energy force applied to shoulder from above<ref name="Grate">Grate I Jr. Luxatio erecta: a rarely seen, but often missed shoulder dislocation. Am J Emerg Med. 2000 May;18(3):317-21.</ref> | ||
*Frequently associated with significant soft tissue injury or fracture<ref name="Imerci" /> | *Frequently associated with significant soft tissue injury or fracture<ref name="Imerci" /> | ||
{{Shoulder dislocation types}} | |||
==Clinical Features== | ==Clinical Features== | ||
*Mechanism: forceful hyper-abduction of arm | |||
*Humerus fully abducted | *Humerus fully abducted | ||
**Hand on or behind head | **Hand on or behind head | ||
| Line 38: | Line 42: | ||
#Place second hand on medial epicondyle of elbow | #Place second hand on medial epicondyle of elbow | ||
#Use first hand to apply pressure to the mid-shaft of the humerus while the second hand pulls the elbow cephalad | #Use first hand to apply pressure to the mid-shaft of the humerus while the second hand pulls the elbow cephalad | ||
#Perform reduction of the [[anterior shoulder | #Perform reduction of the [[anterior shoulder dislocation]] | ||
#Place arm in shoulder immobilizer | #Place arm in shoulder immobilizer | ||
#Obtain post-reduction radiographs | #Obtain post-reduction radiographs | ||
| Line 48: | Line 52: | ||
*Suspected major vascular injury | *Suspected major vascular injury | ||
*In these cases, open reduction is indicated | *In these cases, open reduction is indicated | ||
==Disposition== | ==Disposition== | ||
*Discharge after successful reduction | *Discharge after successful reduction | ||
*Outpatient orthopedic surgery follow-up | *Outpatient orthopedic surgery follow-up | ||
==Complications== | |||
*[[Axillary nerve palsy]] in 60% (usually rapidly resolves after reduction<ref name="Grate" /> | |||
*[[Humerus fracture]] in 37% | |||
*[[Rotator cuff tear]] in 12% | |||
==See Also== | ==See Also== | ||
*[[Shoulder dislocation]] | *[[Shoulder dislocation]] | ||
==External Links== | |||
===Videos=== | |||
{{#widget:YouTube|id=k_ORI51luFI}} | |||
==References== | ==References== | ||
Latest revision as of 13:42, 29 June 2021
Background
- Also known as "Luxatio Erecta" due to the affected arm being held 'erect', in a fully-abducted position
- About 0.5% of shoulder dislocations[1]
- Typically caused by hyperabduction
- Levers the humeral neck against the acromion
- Rarely caused by high-energy force applied to shoulder from above[2]
- Frequently associated with significant soft tissue injury or fracture[1]
Shoulder dislocation types
- Anterior shoulder dislocation (~95%)
- Posterior shoulder dislocation (~5%)
- Inferior shoulder dislocation (<1%)
Clinical Features
- Mechanism: forceful hyper-abduction of arm
- Humerus fully abducted
- Hand on or behind head
- Humeral head palpable in axilla or lateral chest wall[1]
Differential Diagnosis
Shoulder and Upper Arm Diagnoses
Traumatic/Acute:
- Shoulder Dislocation
- Clavicle fracture
- Humerus fracture
- Scapula fracture
- Acromioclavicular joint injury
- Glenohumeral instability
- Rotator cuff tear
- Biceps tendon rupture
- Triceps tendon rupture
- Septic joint
Nontraumatic/Chronic:
- Rotator cuff tear
- Impingement syndrome
- Calcific tendinitis
- Adhesive capsulitis
- Biceps tendinitis
- Subacromial bursitis
- Cervical radiculopathy
Refered pain & non-orthopedic causes:
- Referred pain from
- Neck
- Diaphragm (e.g. gallbladder disease)
- Brachial plexus injury
- Axillary artery thrombosis
- Thoracic outlet syndrome
- Subclavian steal syndrome
- Pancoast tumor
- Myocardial infarction
- Pneumonia
- Pulmonary embolism
Evaluation
- Plain film X-ray in at least 2 views
Management
- Closed reduction
- Consider procedural sedation
Single-Step Technique[3]
- Place sheet over upper shoulder and chest wall
- Have assistant grasp sheet and provide countertraction
- Grasp arm and apply traction upward and outward (along humeral axis)
- Place arm in shoulder immobilizer
- Obtain post-reduction radiographs
Two-Step Technique[4] [5]
- Converts inferior dislocation to anterior dislocation to allow reduction
- Place one hand on the lateral mid-shaft of the humerus
- Place second hand on medial epicondyle of elbow
- Use first hand to apply pressure to the mid-shaft of the humerus while the second hand pulls the elbow cephalad
- Perform reduction of the anterior shoulder dislocation
- Place arm in shoulder immobilizer
- Obtain post-reduction radiographs
- Failure of closed reduction may occur secondary to "buttonholing" of humeral through defect in glenohumeral capsule → consult ortho for open reduction[6]
Contraindications to closed reduction[1]
- Humeral neck or shaft fracture
- Suspected major vascular injury
- In these cases, open reduction is indicated
Disposition
- Discharge after successful reduction
- Outpatient orthopedic surgery follow-up
Complications
- Axillary nerve palsy in 60% (usually rapidly resolves after reduction[2]
- Humerus fracture in 37%
- Rotator cuff tear in 12%
See Also
External Links
Videos
{{#widget:YouTube|id=k_ORI51luFI}}
References
- ↑ 1.0 1.1 1.2 1.3 Imerci A, Gölcük Y, Uğur SG, et al. Inferior glenohumeral dislocation (luxatio erecta humeri): report of six cases and review of the literature. Ulus Travma Acil Cerrahi Derg. 2013 Jan;19(1):41-4.
- ↑ 2.0 2.1 Grate I Jr. Luxatio erecta: a rarely seen, but often missed shoulder dislocation. Am J Emerg Med. 2000 May;18(3):317-21.
- ↑ Amanda E. Horn and Jacob W. Ufberg. Management of Common Dislocations. http://clinicalgate.com/management-of-common-dislocations/
- ↑ Davenport M. Procedures for orthopedic emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.
- ↑ Horn A. Management of Common Dislocations. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014.
- ↑ Lam AC, Shih RD. Luxatio Erecta Complicated By Anterior Shoulder Dislocation During Reduction. Western Journal of Emergency Medicine. 2010;11(1):28-30.