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A - MSRA MSK [11] > [7] Shoulder Dislocation > Flashcards

[7] Shoulder Dislocation Flashcards

1
Q

Why are dislocations of the shoulder common?

A

Because the shoulder is a highly mobile joint, which sacrifices stability for an increased range of movement

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2
Q

What can shoulder dislocations lead to if not managed correctly?

A

Chronic joint instability and pain

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3
Q

What is the most common type of shoulder dislocation?

A

Anteroinferior (usually just termed ‘anterior’)

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4
Q

What % of shoulder dislocations are anteroinferior?

A

Around 95%

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5
Q

What are the less common types of shoulder dislocations?

A
  • Posterior
  • Inferior
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6
Q

What classically causes an anterior shoulder dislocation?

A

Force being applied to an extended, abducted, and externally rotated humerus

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7
Q

What classically causes posterior dislocations?

A

Seizures or electrocution

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8
Q

How can posterior dislocations occur through trauma?

A

Direct blow to the anterior shoulder or force through a flexed, adducted arm

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9
Q

Why are posterior dislocations important diagnostically?

A

They are the most commonly missed dislocation of the shoulder, especially as the radiographic evidence of them can be subtle

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10
Q

How do shoulder dislocations present?

A
  • Painful shoulder
  • Acutely reduced mobility
  • Feeling of instability
  • Reluctance to move affected limb
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11
Q

What may be found on examination in a dislocated shoulder?

A
  • Asymmetry with the contralateral side
  • Loss of shoulder contours
  • Anterior buldge from head of humerus
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12
Q

What is it important to assess in a should dislocation?

A

Neurovascular status of the arm

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13
Q

Which nerves are most likely to be compromised in a shoulder dislocation?

A

Axillary and suprascapular nerves

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14
Q

What bony injuries are commonly associated with shoulder dislocations?

A
  • Bony Bankart lesions
  • Hills-Sachs defects
  • Fractures of greater tuberosity and surgical neck of humerus
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15
Q

What are bony Bankart lesions?

A

Fractures of the anterior inferior glenoid bone

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16
Q

Who are Bankart lesions most commony present in?

A

Those with recurrent dislocations

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17
Q

What are Hills-Sachs lesions?

A

Impaction injuries to the chondral surface of the posterior and superior portions of the humeral head

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18
Q

What % of traumatic dislocations are Hills-Sachs defects present in?

A

Approx 80%

19
Q

What labral and ligamentous injuries can be associated with shoulder dislocations?

A
  • Soft Bankart lesions
  • Glenohumeral ligament avulsion
  • Rotator cuff injuries
20
Q

What are soft Bankart lesions?

A

Avulsions of the anterior labrum and inferior glenohumeral ligament

21
Q

What % of younger shoulder dislocation patients have at least 1 rotator cuff tear?

A

Around 1/3

22
Q

What forms the bulk of investigation for shoulder dislocations?

A

Imaging

23
Q

What imaging is required in shoulder dislocation?

A

A trauma series of plain radiographs

24
Q

What does a shoulder trauma series of plain radiographs consist of?

A

Anterior-posterior, Y-scapular, and axial views

25
Q

How does a trauma series confirm an anterior dislocation of the shoulder?

A

They can usually be seen on the AP film, as it is visibly out of the joint. The Y-scapular view will also confirm that it is anteriorly dislocated

26
Q

What x-ray finding suggests a posterior shoulder dislocation?

A

The ‘light bulb sign’

27
Q

What produces the ‘light-bulb’ sign in posterior dislocations?

A

The humerus is fixed in internal rotation

28
Q

Which x-ray view is useful for differentiating between anterior and posterior dislocations?

A

Y view

29
Q

What investigation should be performed if labral and rotator cuff injuries are suspected?

A

MRI of the shoulder

30
Q

What should the immediate management of shoulder dislocations involve?

A
  • A to E assessment
  • Stabilisation of injury
  • Examination for other injuries
  • Good, appropriate analgesia
31
Q

Why is A to E assessment important in shoulder dislocation?

A

As dislocations frequently occur following trauma

32
Q

How should shoulder dislocations be reduced?

A

Closed reduction, such as Hippocratic method

This should be performed by a trained specialist, involving orthopaedics early before attempting reduction

33
Q

When should neurovascular status be assessed in shoulder dislocation?

A

Pre- and post-reduction

34
Q

What might a failed closed shoulder dislocation reduction warrent?

A

Attempted manipulation under anaesthesia in theatres

35
Q

How should a shoulder dislocation be managed once reduced?

A

Place arm in broad-arm sling

36
Q

How long should the arm be immobilised after shoulder dislocation?

A

Typically 2 weeks for anterior dislocation, longer for posterior dislocations

37
Q

Do all shoulder dislocations require physiotherapy?

A

Yes

38
Q

What is the aim of physiotherapy following shoulder dislocations?

A

Restore range of movement, functionality, and to strengthen the rotator cuff and pericapsular musculature

39
Q

When might further surgical treatment be required in shoulder dislocations?

A

If there is recurrent pain, instability, large Hills-Sachs defects, or large (bony) Bankart lesions

40
Q

What complications might arise from a shoulder dislocation despite treatment?

A
  • Chronic pain
  • Limited mobility
  • Stiffness
  • Recurrence
41
Q

Is recurrence common following a shoulder dislocation?

A

Relatively, particularly in those who continue high risk activities

42
Q

What are the common complications for shoulder dislocations?

A
  • Adhesive capsulitis
  • Nerve damage
  • Rotator cuff injury
  • Degenerate joint disease
43
Q

When does degenerative joint disease typically occur following shoulder dislocations?

A

Typically after labral and cartilaginous injuries and chronic recurrence

A - MSRA MSK [11] (38 decks)

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