Shoulder dislocation

Revision as of 03:08, 11 February 2012 by Jswartz (talk | contribs)

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

  1. Recurrent dislocation (>90% in age <20yr)
  2. Bony injuries:
    1. Usually do not affect management
      1. Hill-Sachs lesion (compression fracture of humeral head)
      2. Bankart lesion (injury to inferior glenoid labrum)
  3. Axillary nerve (usually temporary) and artery (rare)
  4. Rotator cuff tear

Reduction Techniques

  • Traction-Countertraction

Traction-Countertraction.jpg

  • Milch

Milch.jpg

  • External Rotation

External Rotation.jpg

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