Shoulder dislocation: Difference between revisions

Line 45: Line 45:
==Disposition==
==Disposition==
*Uncomplicated dislocation can be discharged after reduction
*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>
**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==

Revision as of 18:25, 16 June 2020

Background

Shoulder anatomy, anterior.
Shoulder anatomy, posterior.
  • Humerus separates from the scapula at the glenohumeral joint
  • Partial dislocation of the shoulder is referred to as subluxation
  • Dislocation duration inversely correlated with likelihood of successful ED reduction

Types

Differential Diagnosis

Shoulder and Upper Arm Diagnoses

Traumatic/Acute:

Nontraumatic/Chronic:

Refered pain & non-orthopedic causes:

Evaluation

Workup

  • Plain film X-ray
    • Include anteroposterior, scapular Y, and axillary views
    • Associated fractures include:
      • Hills-Sachs: cortical depression in the humeral head
      • Bankart: glenoid labrum disruption with bony avulsion
      • Humeral greater tuberosity fracture
  • Consider joint ultrasound

Diagnosis

Management

Reduction

  • 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]
  • See individual types for specific techniques:

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.