ANTERIOR SHOULDER DISLOCATION

Question 1

MANAGEMENT

Answer 1

MECHANISM
Abduction
Extension
External Rotation
Significant force + 1st time dislocation = significant acute ligament damage

PHYSICAL EXAM
Squared off shoulder
Arm in slight abduction and external rotation
Patient resists adduction and internal rotation
Check axillary nerve

XRAY
Shoulder Series: AP + Lateral Scapular (“Y”) view
Axillary View
+- velpo

REDUCTION
1. Traction-Countertraction Technique (Modified Hippocratic):
Patient is supine with arm abducted and elbow flexed at 90 degrees
Physician provides traction on proximal forearm with internal external rotation
Sheet wrapped around patient and assisstant for countertraction

2. External Rotation Technique (Kocher’s Technique):
   Patient is supine
   Arm addicted to the patient’s side
   Elbow flexed to 90 degrees
   Slowly externally rotate the arm
   POST-REDUCTION
   1st time anterior shoulder dislocation: shoulder immobilizer up to 3 weeks
   Follow up with ortho in 1 week, 1-2 days if complicated

COMPLICATIONS
Recurrence (MC complication)
Proximal humeral fractures (incidence increases with age)
Rotator cuff tears (incidence increases with age)
Hill-Sachs deformity (humeral head bony defect)
Bankart lesion (glenoid labral defect)
Bony-Bankart lesion (glenoid bony defect)
Neurovascular injuries (Axiallry a. & n.) (rare)