Posterior shoulder dislocation: Difference between revisions
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==Background== | ==Background== | ||
* | *Accounts for 2-4% of shoulder dislocations<ref>Grate I Jr. Luxatio erecta: a rarely seen, but often missed shoulder dislocation. Am J Emerg Med. 2000 May;18(3):317-21.</ref> | ||
*MOI - forceful internal rotation/adduction (2/2 e.g. seizure, electric shock) or blow to ant shoulder | |||
*Neurovascular and rotator cuff tears are less common than in ant dislocations | *Neurovascular and rotator cuff tears are less common than in ant dislocations | ||
| Line 16: | Line 17: | ||
==Management== | ==Management== | ||
*Reduce | *Reduce | ||
**Consider [[procedural sedation]] | |||
**Traction applied to adducted arm in long axis of humerus | **Traction applied to adducted arm in long axis of humerus | ||
**Assistant pushes humeral head anteriorly into glenoid fossa | **Assistant pushes humeral head anteriorly into glenoid fossa | ||
* | *Post-reduction X-ray | ||
*Apply sling | |||
==Disposition== | ==Disposition== | ||
Revision as of 22:16, 4 July 2015
Background
- Accounts for 2-4% of shoulder dislocations[1]
- MOI - forceful internal rotation/adduction (2/2 e.g. seizure, electric shock) or blow to ant shoulder
- Neurovascular and rotator cuff tears are less common than in ant dislocations
Clinical Features
- Prominence of posterior shoulder and ant flattening of normal shoulder contour
- Pt unable to rotate or abduct affected arm
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
- Plain film X-ray
- Scapular "Y" view shows humeral head in posterior position
Management
- Reduce
- Consider procedural sedation
- Traction applied to adducted arm in long axis of humerus
- Assistant pushes humeral head anteriorly into glenoid fossa
- Post-reduction X-ray
- Apply sling
Disposition
- Discharge after reduction
- Ortho follow-up
See Also
References
- ↑ Grate I Jr. Luxatio erecta: a rarely seen, but often missed shoulder dislocation. Am J Emerg Med. 2000 May;18(3):317-21.