Inferior shoulder dislocation: Difference between revisions
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*Accounts for ~0.5% of all shoulder dislocations<ref name="Imerci" /> | *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 | ||
**Can also be 2/2 high-energy force applied directly 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 w/ significant soft tissue injury or fracture<ref name="Imerci" /> | *Frequently associated w/ significant soft tissue injury or fracture<ref name="Imerci" /> | ||
**Axillary nerve palsy in 60% | **Axillary nerve palsy in 60% (usually rapidly resolves after reduction<ref name="Grate" /> | ||
**Humerus fracture in 37% | **Humerus fracture in 37% | ||
**Rotator cuff tear in 12% | **Rotator cuff tear in 12% | ||
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==Diagnosis== | ==Diagnosis== | ||
*Plan film X-ray | *Plan film X-ray in at least 2 views | ||
==Management== | ==Management== | ||
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**Consider [[Procedural sedation]] | **Consider [[Procedural sedation]] | ||
**Apply traction in upward and outward direction (along same axis as humerus) | **Apply traction in upward and outward direction (along same axis as humerus) | ||
** | **Simultaneously apply counter-traction with sheet on upper shoulder and chest wall. | ||
*Apply sling | *Apply sling with arm in adduction and internal rotation. | ||
*Post-reduction X-ray | *Post-reduction X-ray | ||
*''Failure of closed reduction may occur 2/2 "buttonholing" of humeral through defect in glenohumeral capsule → consult ortho for open reduction''<ref>Lam AC, Shih RD. Luxatio Erecta Complicated By Anterior Shoulder Dislocation During Reduction. Western Journal of Emergency Medicine. 2010;11(1):28-30.</ref> | |||
===Contraindications to closed reduction<ref name="Imerci" />=== | ===Contraindications to closed reduction<ref name="Imerci" />=== | ||
Revision as of 22:34, 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
- Can also be 2/2 high-energy force applied directly to shoulder from above[2]
- Frequently associated w/ significant soft tissue injury or fracture[1]
- Axillary nerve palsy in 60% (usually rapidly resolves after reduction[2]
- 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[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
Diagnosis
- Plan film X-ray in at least 2 views
Management
- Closed reduction
- Consider Procedural sedation
- Apply traction in upward and outward direction (along same axis as humerus)
- Simultaneously apply counter-traction with sheet on upper shoulder and chest wall.
- Apply sling with arm in adduction and internal rotation.
- Post-reduction X-ray
- Failure of closed reduction may occur 2/2 "buttonholing" of humeral through defect in glenohumeral capsule → consult ortho for open reduction[3]
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
- Ortho follow-up
See Also
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.
- ↑ Lam AC, Shih RD. Luxatio Erecta Complicated By Anterior Shoulder Dislocation During Reduction. Western Journal of Emergency Medicine. 2010;11(1):28-30.