Inferior shoulder dislocation

Background

• Also known as "Luxatio Erecta" due to the presentation of arm held in full abduction
• Accounts for ~0.5% of all shoulder dislocations
• MOI is typically hyperabduction force which levers the humeral neck against the acromion
• Frequently associated w/ significant soft tissue injury or fracture
  • 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

Differential Diagnosis

Shoulder and Upper Arm Diagnoses

Traumatic/Acute:

• Shoulder Dislocation
  • Anterior shoulder dislocation
  • Posterior shoulder dislocation
  • Inferior 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
  • Rucksack paralysis
• 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

• 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

• Shoulder dislocation