Difference between revisions of "Posterior shoulder dislocation"

(Clinical Features)
(Management)
Line 26: Line 26:
  
 
==Management==
 
==Management==
*Reduce
+
*Closed reduction
**Consider [[procedural sedation]]
+
**Most require [[procedural sedation]]
**Traction applied to adducted arm in long axis of humerus
+
#Adduct the arm
**Assistant pushes humeral head anteriorly into glenoid fossa
+
#Apply traction along long axis of humerus
*Post-reduction X-ray
+
#Have assistant push humeral head anteriorly into glenoid fossa
*Apply sling
+
#Apply shoulder immobilizer
 
+
#Obtain post-reduction radiographs
 
*'''Note: Do not reduce chronic dislocations (>4 weeks) in the ED due to risk of arterial injury''' - consult ortho for open reduction
 
*'''Note: Do not reduce chronic dislocations (>4 weeks) in the ED due to risk of arterial injury''' - consult ortho for open reduction
  

Revision as of 23:55, 13 May 2019

Background

  • 2-4% of shoulder dislocations[1]
  • Causes:
    • Forceful internal rotation and adduction
      • Usually due to seizure or electric shock
        • Consider in alcohol withdrawal, even without clear history of shoulder
    • Blow to anterior shoulder
  • Complications (neurovascular injuries and rotator cuff tears) less common than in anterior dislocation
  • May go undetected for extended period as often missed on physical exam and imaging

Clinical Features

  • Posterior aspect of shoulder unusually prominent
  • Anterior aspect of shoulder appears flattened
  • Inability to rotate or abduct affected arm

Differential Diagnosis

Shoulder and Upper Arm Diagnoses

Traumatic/Acute:

Nontraumatic/Chronic:

Refered pain & non-orthopedic causes:

Evaluation

Light bulb sign (right picture) with post-reduction comparison (left picture)
  • Plain film X-ray
    • Scapular "Y" view shows humeral head in posterior position
    • Lack of normal overlap of humeral head and glenoid fossa
    • "Light bulb sign" - fixed internal rotation makes for light bulb appearance of humeral head on AP
  • Bedside ultrasound can be used to assess for both dislocation and successful reduction

Management

  1. Adduct the arm
  2. Apply traction along long axis of humerus
  3. Have assistant push humeral head anteriorly into glenoid fossa
  4. Apply shoulder immobilizer
  5. Obtain post-reduction radiographs
  • Note: Do not reduce chronic dislocations (>4 weeks) in the ED due to risk of arterial injury - consult ortho for open reduction

Disposition

  • Discharge after reduction
  • Ortho follow-up

See Also

External Links

References

  1. Grate I Jr. Luxatio erecta: a rarely seen, but often missed shoulder dislocation. Am J Emerg Med. 2000 May;18(3):317-21.