Shoulder dislocation: Difference between revisions

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==Background==
==Background==
*Humerus separates from the scapula at the glenohumeral joint.
[[File:Gray326.png|thumb|Left shoulder and acromioclavicular joints with ligaments.]]
*Partial dislocation of the shoulder is referred to as subluxation.
[[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
*Partial dislocation of the shoulder is referred to as subluxation
*Dislocation duration inversely correlated with likelihood of successful ED reduction


===Types===
{{Shoulder dislocation types}}
*[[Anterior shoulder dislocation]]
*[[Posterior shoulder dislocation]]
*[[Inferior shoulder dislocation]]


==Diagnosis==
==Differential Diagnosis==
{{Shoulder DDX}}
 
==Evaluation==
===Workup===
*Plain film X-ray
*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 [[Ultrasound: Joint|joint ultrasound]]


==Differential Diagnosis==
===Diagnosis===
{{Shoulder DDX}}
<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.
*'''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]]


*Cochrane review notes lower complications, equal pain control, and shorter ED stay with intra-articular lidocaine vs. procedural sedation
===Post-Reduction===
**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>
*Post-reduction film to confirm
*Sling and swathe or shoulder immobilizer x1 week / until orthopedics follow-up
**Encourage daily range of motion exercises (minus abduction + external rotation) to prevent adhesive capsulitis


==Disposition==
==Disposition==
*Uncomplicated dislocation can be discharged after reduction.
*Uncomplicated dislocation can be discharged after reduction
*See individual types for specific management.
 
==Prognosis==
*Recurrence rate around 27% if older than 30 years and 72% if 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==
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*[http://www.youtube.com/watch?v=d9HjtQr0c64 Good all-round shoulder reduction technique lecture]
*[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]
*[http://thecentralline.org/?p=1769 Keeping Up in EM Shoulder Reduction Video]
*[https://www.merckmanuals.com/professional/injuries-poisoning/dislocations/shoulder-dislocations?query=shoulder%20dislocation Merk Manual - Shoulder dislocations]
==Video==
{{#widget:YouTube|id=WPAEBZUOW6c}}


==References==
==References==
<references/>
<references/>


[[Category:Ortho]]
[[Category:Orthopedics]]
[[Category:Procedures]]
[[Category:Procedures]]

Revision as of 02:19, 21 August 2021

Background

Left shoulder and acromioclavicular joints with ligaments.
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

Shoulder dislocation 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

Post-Reduction

  • Post-reduction film to confirm
  • Sling and swathe or shoulder immobilizer x1 week / until orthopedics follow-up
    • Encourage daily range of motion exercises (minus abduction + external rotation) to prevent adhesive capsulitis

Disposition

  • Uncomplicated dislocation can be discharged after reduction

Prognosis

  • Recurrence rate around 27% if older than 30 years and 72% if 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.