Shoulder dislocation: Difference between revisions

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==Background==
==Background==
*>99% are anterior dislocation assoc w/ indirect blow
*Humerus separates from the scapula at the glenohumeral joint
*Must rule-out axillary nerve injury
*Partial dislocation of the shoulder is referred to as subluxation
*Consider intra-articular lidocaine (10-20mL) as alternative to procedural sedation


==Clinical Features==
===Types===
*Arm held in abduction w/ shoulder lacking normal rounded contour
*[[Anterior shoulder dislocation]]
*Difficulty (painful) touching ipsilateral arm to contralateral shoulder
*[[Posterior shoulder dislocation]]
*[[Inferior shoulder dislocation]]


==Imaging==
==Differential Diagnosis==
*Prereduction radiographs advised for traumatic mechanism (rule-out fx-dislocation)
{{Shoulder DDX}}
*AP
**Will show dislocation
*Scapular lateral or "Y"
**Will show whether dislocation is anterior or posterior


==Reduction Techniques==
==Evaluation==
*Traction-Countertraction
*Plain film X-ray
[[File:Traction-Countertraction.jpg]]
*[[Ultrasound: Joint|Ultrasound]]
*Milch
[[File:Milch.jpg]]
*External Rotation
[[File:External Rotation.jpg]]


<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>


**Types:
==Management==
***Subcoracoid
*Reduction
***Subglenoid
**See individual types for specific techniques
***Subclavicular
**'''Do not attempt to reduce chronic dislocations (>4 weeks) in ED due to risk of arterial injury''' - these require reduction in the OR
***Intrathoracic
*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>


When the shoulder is anteriorly dislocated, two additional nerves, the axillary (supplying sensation to the lateral aspect of the shoulder) and the musculocutaneous (supplying sensation to the extensor aspect of the forearm), also should be checked.  
==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>


*Dislocation + proximal humerus fx require ortho consult
==See Also==
 
*[[Shoulder diagnoses]]
 
 
==Management==


==External Links==
*[http://www.youtube.com/watch?v=d9HjtQr0c64 Good all-round shoulder reduction technique lecture]
*[http://thecentralline.org/?p=1769 Keeping Up in EM Shoulder Reduction Video]


==Source==
==Video==
*Tintinalli
{{#widget:YouTube|id=WPAEBZUOW6c}}


==References==
<references/>


[[Category:Ortho]]
[[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.