Inferior shoulder dislocation: Difference between revisions
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==Background== | ==Background== | ||
*Also known as "Luxatio Erecta" due to the presentation of arm held in full abduction | *Also known as "Luxatio Erecta" due to the presentation of arm held in full abduction | ||
* | *Accounts for ~0.5% of all shoulder dislocations<ref name="imerci" /> | ||
*MOI is typically hyperabduction force which levers the humeral neck against the acromion | *MOI is typically hyperabduction force which levers the humeral neck against the acromion | ||
*Frequently associated w/ significant soft tissue injury or fracture<ref name="imerci" /> | |||
**Axillary nerve palsy in 60% | |||
**Humerus fracture in 37% | |||
**Rotator cuff tear in 12% | |||
==Clinical Features== | ==Clinical Features== | ||
*Pt p/w humerus fully abducted with hand on or behind the head | *Pt p/w humerus fully abducted with hand on or behind the head | ||
*Humeral head can be palpated on lateral chest wall | *Humeral head can be palpated on axilla or lateral chest wall<ref name="Imerci">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.</ref> | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revision as of 21:10, 4 July 2015
Background
- Also known as "Luxatio Erecta" due to the presentation of arm held in full abduction
- Accounts for ~0.5% of all shoulder dislocations[1]
- MOI is typically hyperabduction force which levers the humeral neck against the acromion
- Frequently associated w/ significant soft tissue injury or fracture[1]
- Axillary nerve palsy in 60%
- Humerus fracture in 37%
- Rotator cuff tear in 12%
Clinical Features
- Pt p/w humerus fully abducted with hand on or behind the head
- Humeral head can be palpated on axilla or lateral chest wall[2]
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
Diagnosis
- Plan film X-ray
Management
- Reduce
- Traction in upward and outward direction
- Apply sling
Disposition
- Discharge after reduction
- Ortho follow-up (rotator cuff tear is the norm)