Shoulder dislocation
Anterior Dislocation
Background
- >99% are anterior dislocation assoc w/ indirect blow
- Must rule-out axillary nerve injury
- Consider intra-articular lidocaine (10-20mL) as alternative to procedural sedation
Clinical Features
- Arm held in abduction w/ shoulder lacking normal rounded contour
- Difficulty (painful) touching ipsilateral arm to contralateral shoulder
Imaging
- Prereduction radiographs advised for traumatic mechanism (rule-out fx-dislocation)
- AP
- Will show dislocation
- Scapular lateral or "Y"
- Will show whether dislocation is anterior or posterior
Management
- Reduce (see techniques below)
- Post-reduction: sling w/ shoulder in adduction/internal rotation
- Ortho referral for 1st-time dislocation
Complications
- Recurrent dislocation (>90% in age <20yr)
- Bony injuries:
- Usually do not affect management
- Hill-Sachs lesion (compression fracture of humeral head)
- Bankart lesion (injury to inferior glenoid labrum)
- Usually do not affect management
- Axillary nerve (usually temporary) and artery (rare)
- Rotator cuff tear
Reduction Techniques
- Traction-Countertraction
- Milch
- External Rotation
Posterior Dislocation
Background
- Via forceful internal rotation/adduction (sz, electric shock) or blow to ant shoulder
- Neurovascular and rotator cuff tears are less common than in ant dislocations
=Clinical Features
- Prominence of posterior shoulder and ant flattening of normal shoulder contour
- Pt unable to rotate or abduct affected arm
Imaging
- Scapular "Y" view shows humeral head in posterior position
Management
- Reduce
- Traction applied to adducted arm in long axis of humerus
- Assistant pushes humeral head anteriorly into glenoid fossa
- Spling, ortho f/u
Inferior Dislocation
Background
- Assoc w/ significant soft tissue trauma or fracture
- Via hyperabduction force which levers the humeral neck against the acromion
Clinical Features
- Pt p/w humerus fully abducted with hand on or behind the head
- Humeral head can be palpated on lateral chest wall
Management
- Reduce
- Traction in upward and outward direction
- Sling, ortho f/u (rotator cuff tear is the norm)
Source
- Tintinalli