Shoulder dislocation: Difference between revisions

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==Background==
==Background==
*Humerus separates from the scapula at the glenohumeral joint
*Partial dislocation of the shoulder is referred to as subluxation


==Types==
===Types===
*[[Shoulder dislocation]]
*[[Anterior shoulder dislocation]]
**[[Anterior shoulder dislocation]]
*[[Posterior shoulder dislocation]]
**[[Posterior shoulder dislocation]]
*[[Inferior shoulder dislocation]]
**[[Inferior shoulder dislocation]]


==Chronic Anterior Dislocation==
==Differential Diagnosis==
Calvet describes a high risk of axillary artery rupture in chronic dislocation (68 out of 91 chronic anterior shoulder dislocations)<ref>Calvet, E et al. [Dislocations of the shoulder and vascular le- sions.] (in French). J Chir (Paris) 1941; 58: 337-346.</ref>Verhaegen reported two cases of axillary artery rupture in patients with reduction of a chronic shoulder dislocation (12 weeks)<ref>Verhaegen F, et al. Chronic anterior shoulder dislocation: as- pects of current management and potential complications. Acta Orthop Belg. 2012 Jun;78(3):291-5. PMID: 22822566.</ref> A safe rule would be orthopedic consultation and proceed with caution in patients with 3-4 week dislocation<ref>Sahajpal DT, et al. Chronic glenohumeral dislocation. J Am Acad Orthop Surg. 2008 Jul;16(7):385-98.</ref>
{{Shoulder DDX}}


==Evaluation==
*Plain film X-ray
*[[Ultrasound: Joint|Ultrasound]]


==Differential Diagnosis==
<gallery mode="packed">
{{Shoulder DDX}}
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==
*See individual types for specific 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
*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>
==Disposition==
*Uncomplicated dislocation can be discharged after reduction
*Recurrence rate around 27% if older than 30 years and 72% is younger than 23 years<ref>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.</ref>


==See Also==
==See Also==
*[[Shoulder diagnoses]]
*[[Shoulder diagnoses]]
==Sources==
<references/>


==External Links==
==External Links==
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*[http://thecentralline.org/?p=1769 Keeping Up in EM Shoulder Reduction Video]
*[http://thecentralline.org/?p=1769 Keeping Up in EM Shoulder Reduction Video]


[[Category:Ortho]]
==Video==
{{#widget:YouTube|id=WPAEBZUOW6c}}
 
==References==
<references/>
 
[[Category:Orthopedics]]
[[Category:Procedures]]

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:

Nontraumatic/Chronic:

Refered pain & non-orthopedic causes:

Evaluation

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

  1. ↑ 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
  2. ↑ 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.
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