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 | ||
*Frequently associated w/ significant soft tissue injury or fracture<ref name=" | *Frequently associated w/ significant soft tissue injury or fracture<ref name="Imerci" /> | ||
**Axillary nerve palsy in 60% | **Axillary nerve palsy in 60% | ||
**Humerus fracture in 37% | **Humerus fracture in 37% | ||
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==Management== | ==Management== | ||
* | *Closed reduction | ||
** | **Consider [[Procedural sedation]] | ||
**Apply traction in upward and outward direction (along same axis as humerus) | |||
**Counter-traction with sheet may be helpful | |||
*Apply sling | *Apply sling | ||
*Post-reduction X-ray | |||
===Contraindications to closed reduction<ref name="Imerci" />=== | |||
*Humeral neck or shaft fracture | |||
*Suspected major vascular injury | |||
*In these cases, open reduction is indicated | |||
==Disposition== | ==Disposition== | ||
*Discharge after reduction | *Discharge after successful reduction | ||
*Ortho follow-up | *Ortho follow-up | ||
==See Also== | ==See Also== | ||
Revision as of 21:38, 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[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
Management
- Closed reduction
- Consider Procedural sedation
- Apply traction in upward and outward direction (along same axis as humerus)
- Counter-traction with sheet may be helpful
- Apply sling
- Post-reduction X-ray
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