Inferior shoulder dislocation
Background
- Assoc w/ significant soft tissue trauma or fracture
- Via hyperabduction force which levers the humeral neck against the acromion
Clinical Features
- Pt p/w humerus fully abducted with hand on or behind the head
- Humeral head can be palpated on lateral chest wall
Diagnosis
- Plan film X-ray
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
Management
- Reduce
- Traction in upward and outward direction
- Apply sling
Disposition
- Discharge after reduction
- Ortho follow-up (rotator cuff tear is the norm)