Glenohumeral Joint Dislocation Flashcards
GH joint is what kind of joint
ball and socket, multidirectional
Function holds the tendon of the biceps brachii in place during GH movement
Transverse humeral ligament
most common before age
40
ligaments and capsule
give away
younger patients
can lead to an avulsion
fracture ie flap fracture
older patients
______ shoulder dislocations account for
approximately 95% of all acute shoulder dislocations
anterior
4 subtypes of shoulder dislocations
▪ sub-coracoid
▪ sub-clavicular
▪ sub-glenoid
▪ intrathoracic
primarily due to weakness of theRecurrent anterior shoulder dislocations are
middle and superior gleno-humeral ligaments
via: Foramen of Weitbrecht**
▪ caused by arm being forced into external
rotation and horizontal abduction with the
shoulder flexed to 90 degrees ▪ m/c in men 18-25
Anterior dislocation
falling on
outstretched arm ▪ Bilaterally with electric shock and epileptic
seizures
rare - 4%
posterior dislocation
▪ needs considerable vertical force of the
humerus
▪ usually associated with suprahumeral fracture
superior dislocation
▪ Severe Hyperabduction trauma ▪ Humeral head contacts the acromion which acts as a fulcrum and forces the head inferiorly ▪ Can remain locked in hyperabduction
Inferior (Luxatio Erecta) dislocation
▪ anterior jt pain ▪ history of trauma ▪ interruption of normal shoulder contour with a
posterior bony prominence ▪ paresthesia / numbness in arm ▪ dead arm syndrome
anterior dislocation
▪ posterior shoulder pain ▪ most common sign - stuck in IR. No ER ▪ prominence of anterior acromium
posterior dislocation
patient’s arm at side and doctor pulls down on elbow while palpating GH joint and feels increased motion
sulcus test
Pt reaches across body, places hand on
opposite shoulder and pulls elbow towards chest. Dr
can apply A-P pressure on flexed elbow. Positive if
unable to finish test.
Dugas’ test
adduction across
chest at 45 degrees and forward flexion at 90
degrees
Posterior Apprehension
(SLAP)
Superior Labrum Anterior to Posterior
Common in throwing athletes who present with a ▪ Mechanism - a crushing injury of the labrum between the humeral head and glenoid
SLAP lear
physical exam for SLAP
positive “clunk” test
typically you need what kind of image to spot SLAP tear
MRI w/ contrast
Fraying of the superior labrum with firm attachment of the labrum to the glenoid. Typically degenerative.
type 1 slap
Detachment of the superior labrum and the origin of the tendon of the long head of the biceps from the glenoid resulting in instability of the labral- biceps anchor
type II slap
Bucket-handle tear of the labrum with intact biceps insertion.
type III slap
Impaction fracture of the humeral head on the inferior glenoid rim. MRI is extremely sensitive and specific in locating lesion.
hill-sachs lesion
Avulsion
of the inferior glenoid rim at
the insertion of the triceps
muscle
bankart lesion
tx:
▪ gentle supported pendulum exercises
▪ Isometric exercises with arm at side
▪ Maintain fitness in other arm
Early post reduction (up to 3 weeks)
tx: ▪ Tubing exercises as tolerated stim ▪ No abduction beyond 45 degrees ▪ no ER beyond neutral ▪ Increase proprioception/ sensory motor
Early capsular Healing (3-6 weeks)
tx:
beyond neutral or abduction beyond 90 degrees.
▪ Do not work end ROM unless stiff
▪ closed chain proprioception
▪ supervised resisted training, but not in ER
Intermediate Rehab
tx:
▪ Full ROM ▪ Plyometrics ▪ speed and endurance ▪ sport/ activity specific training
Final Rehab
Appropriate
weights (e.g., 5 pounds) are taped to the wrist of the dislocated shoulder which hangs free over the edge of the table.
Stimson’s Technique
The surgeon stands on the side of the
dislocated shoulder near the patient’s waist with the elbow of the dislocated shoulder bent to 90 degrees. A second sheet, tied loosely around the surgeon’s waist and looped over the patient’s forearm, provides traction while the surgeon leans back against the sheet while grasping the forearm. Steady traction along the axis of the arm usually causes reduction
Matsen’s method (anterior reduction)
The heel does not go into the armpit but extends against the chest wall. The traction is slow and gentle. The arm may be gently rotated internally and externally to disengage the head of the humerus. The one pictured here uses a child to provide countertraction.
Hippocrates Technique
