Shoulder Dislocation Flashcards
ESSENCE
Head of humerus comes entirely out of the glenoiod cavity of scapula
Most common direction
- Anterior displocations (90%)
- Head of humerus moves anteriorly in relaiton to glenoid cavity
AETIOLOGY
Differences between anterior and posterior
Anterior - arm forced backwards whilst abducted and extended (falling on outstretched arm)
Posterior - electric shocks and seizures
What is some associated damage
- Bankart lesions
- Tears to anterior portion of labrum
- Hill-Sachs lesions
- Compression fractures to posterolateral part of head of humerus
- Axillary nerve damage
- Fractures
- Rotator cuff tears
Signs of axillary nerve damage
- Loss of sensation over regimental badge area
- Weakness in deltoid and teres minor muscles
Fractures associated with shoulder dislocation
- Humeral head
- Greater tuberosity of humerus
- Acromion of scapula
- Clavicle
CLINICAL FEATURES
Presentation
- Acute injury
- Usually hol darm against side of body, deltoid appears flattended and head of humerus will cause a bulge and be palpable from front
INVESTIGATIONS
First choice
- Apprehension test
- X-ray - confirm dislocation and exclude fracture
- MRI with contrast - assess for damage such as Bankart and Hill-Sachs lesions and to plan for surgery
- Arthroscopy - camera into shoulder to visualise structures
What is apprehension test
- Special test for shoulder instability, specifically in anterior direction
- Likely to be positive after previous anterior dislocation or subluxation
- Patient lies supin, shoulder is abducted to 90 degrees and elbows flexed to 90, shoulder slowly externally rotated and watch patient, as arm approaches 90 degrees of external roation patients with shoulder instability become anxious, worried that should will dislocate
MANAGEMENT
Acute management gerneral principles
- Shoulder relocated as soon as possible
- Analgesia
- Gas and air
- Broad arm sling to support arm
- Closed reduction of shoulder (after excluding fractures)
- Dislocations associated with fracture may need surgery
- Post-reduction x-rays
- Immobilisation for period
What gas and air may be used in acute management
- Entonox
- 50% nitrous oxide and 50% oxygen
MANAGEMENT
Ongoing management general principles
- Physiotherapy
- Shoulder stabilisation surgery might be needed to correct underlying structural problems
- Bankart lesions
- Tightended shoulder capsule
- Hill-Sachs lesions
- Bony injury to glenoid rim
What procedure fixes bony injury to glenoid rim
- Latarjet procedure
- Bone graft using bone from coracoid process
What procedure corrects Hill-Sachs lesions
Remplissage procedure