Shoulder dislocation: Difference between revisions
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==Background== | ==Background== | ||
*Humerus separates from the scapula at the glenohumeral joint | *Humerus separates from the scapula at the glenohumeral joint | ||
*Partial dislocation of the shoulder is referred to as subluxation | *Partial dislocation of the shoulder is referred to as subluxation | ||
===Types=== | ===Types=== | ||
| Line 7: | Line 7: | ||
*[[Posterior shoulder dislocation]] | *[[Posterior shoulder dislocation]] | ||
*[[Inferior shoulder dislocation]] | *[[Inferior shoulder dislocation]] | ||
==Differential Diagnosis== | |||
{{Shoulder DDX}} | |||
==Evaluation== | ==Evaluation== | ||
*Plain film X-ray | *Plain film X-ray | ||
*[[Ultrasound: Joint|Ultrasound]] | |||
= | <gallery mode="packed"> | ||
File:AnterDisAPMark.png|[[Anterior shoulder dislocation]] | |||
File:AnterDisMark.png|[[Anterior shoulder dislocation]] on Y-view | |||
File:Luxation epaule.png|[[Anterior shoulder dislocation]] with fracture | |||
File:Inferiourdislocation.jpg|[[Inferior shoulder dislocation]] | |||
File:Lightbulb sign - posterior shoulder dislocation - Roe vor und nach Reposition 001.jpg|[[Posterior shoulder dislocation]] | |||
</gallery> | |||
==Management== | ==Management== | ||
*Reduction | *Reduction | ||
**See individual types for specific techniques | **See individual types for specific techniques | ||
**'''Do not attempt to reduce chronic dislocations (>4 weeks) in ED due to risk of arterial injury''' - these require reduction in the OR | |||
*Cochrane review notes lower complications, equal pain control, and shorter ED stay with intra-articular lidocaine vs. procedural sedation | *Cochrane review notes lower complications, equal pain control, and shorter ED stay with intra-articular lidocaine vs. procedural sedation | ||
**20 mL of 1% lidocaine intra-articular injection<ref>Intra-articular lignocaine versus intravenous analgesia with or without sedation for manual reduction of acute anterior shoulder dislocation in adults (Review) Cochrane Database Syst Rev. 2011 Apr 13;(4):CD004919 [http://www.update-software.com/BCP/WileyPDF/EN/CD004919.pdf full text]</ref> | **20 mL of 1% lidocaine intra-articular injection<ref>Intra-articular lignocaine versus intravenous analgesia with or without sedation for manual reduction of acute anterior shoulder dislocation in adults (Review) Cochrane Database Syst Rev. 2011 Apr 13;(4):CD004919 [http://www.update-software.com/BCP/WileyPDF/EN/CD004919.pdf full text]</ref> | ||
Revision as of 17:24, 13 July 2017
Background
- Humerus separates from the scapula at the glenohumeral joint
- Partial dislocation of the shoulder is referred to as subluxation
Types
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
Evaluation
- Plain film X-ray
- Ultrasound
Anterior shoulder dislocation on Y-view
Anterior shoulder dislocation with fracture
Management
- Reduction
- See individual types for specific techniques
- Do not attempt to reduce chronic dislocations (>4 weeks) in ED due to risk of arterial injury - these require reduction in the OR
- Cochrane review notes lower complications, equal pain control, and shorter ED stay with intra-articular lidocaine vs. procedural sedation
- 20 mL of 1% lidocaine intra-articular injection[1]
Disposition
- Uncomplicated dislocation can be discharged after reduction
- Recurrence rate around 27% if older than 30 years and 72% is younger than 23 years[2]
See Also
External Links
Video
{{#widget:YouTube|id=WPAEBZUOW6c}}
References
- ↑ Intra-articular lignocaine versus intravenous analgesia with or without sedation for manual reduction of acute anterior shoulder dislocation in adults (Review) Cochrane Database Syst Rev. 2011 Apr 13;(4):CD004919 full text
- ↑ Watson S, Allen B, Grant JA. A Clinical Review of Return-to-Play Considerations After Anterior Shoulder Dislocation. Sports Health. 2016; 8(4):336-341.