Shoulder dislocation: Difference between revisions
(19 intermediate revisions by the same user not shown) | |||
Line 1: | Line 1: | ||
==Background== | ==Background== | ||
[[File:Gray326.png|thumb|Left shoulder and acromioclavicular joints with ligaments.]] | |||
[[File:Shoulder_joint_back-en.png|thumb|Shoulder anatomy, anterior.]] | |||
[[File:Shoulder joint back 05r4v.png|thumb|Shoulder anatomy, posterior.]] | |||
*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 | ||
*Dislocation duration inversely correlated with likelihood of successful ED reduction | |||
{{Shoulder dislocation types}} | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Line 12: | Line 13: | ||
==Evaluation== | ==Evaluation== | ||
===Workup=== | |||
*Plain film X-ray | *Plain film X-ray | ||
**Include anteroposterior, scapular Y, and axillary views | **Include anteroposterior, scapular Y, and axillary views | ||
Line 18: | Line 20: | ||
***Bankart: glenoid labrum disruption with bony avulsion | ***Bankart: glenoid labrum disruption with bony avulsion | ||
***Humeral greater tuberosity fracture | ***Humeral greater tuberosity fracture | ||
*[[Ultrasound: Joint| | *Consider [[Ultrasound: Joint|joint ultrasound]] | ||
===Diagnosis=== | |||
<gallery mode="packed"> | <gallery mode="packed"> | ||
File:AnterDisAPMark.png|[[Anterior shoulder dislocation]] | File:AnterDisAPMark.png|[[Anterior shoulder dislocation]] | ||
Line 29: | Line 32: | ||
==Management== | ==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 | |||
*Lower complications, equal pain control, and shorter ED stay with intra-articular lidocaine vs. procedural sedation<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 | ||
*See individual types for specific techniques: | |||
**[[Anterior shoulder dislocation]] | |||
**[[Posterior shoulder dislocation]] | |||
**[[Inferior shoulder dislocation]] | |||
==Disposition== | ==Disposition== | ||
*Uncomplicated dislocation can be discharged after reduction | *Uncomplicated dislocation can be discharged after reduction | ||
==Prognosis== | |||
*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> | ||
Revision as of 20:05, 22 June 2020
Background
- 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
Shoulder dislocation types
- Anterior shoulder dislocation (~95%)
- Posterior shoulder dislocation (~5%)
- Inferior shoulder dislocation (<1%)
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
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
Anterior shoulder dislocation on Y-view
Anterior shoulder dislocation with fracture
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
- Lower complications, equal pain control, and shorter ED stay with intra-articular lidocaine vs. procedural sedation[1]
- 20 mL of 1% lidocaine intra-articular injection
- See individual types for specific techniques:
Disposition
- Uncomplicated dislocation can be discharged after reduction
Prognosis
- 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.