shoulder dislocation

Question 1

what is a shoulder dislocation?

Answer 1

where the ball of the shoulder (head of the humerus) comes entirely out of the socket (glenoid cavity of the scapula).

Question 2

what is subluxation?

Answer 2

Subluxation refers to a partial dislocation of the shoulder. The ball does not come fully out of the socket and naturally pops back into place shortly afterwards.

Question 3

what is the main type of shoulder dislocation?

Answer 3

anterior

Question 4

what types of injuries are associated with posterior dislocations?

Answer 4

electric shocks and seizures.

Question 5

what is the key complication associated with anterior shoulder dislocations?

Answer 5

Axillary nerve damage is a key complication. The axillary nerve comes from the C5 and C6 nerve roots. Damage causes a loss of sensation in the “regimental badge” area over the lateral deltoid. It also leads to motor weakness in the deltoid and teres minor muscles.

Question 6

what things should you assess in a person with shoulder dislocation?

Answer 6

Fractures
Vascular damage (e.g., absent pulses, prolonged capillary refill time and pallor)
Nerve damage (e.g., loss of sensation in the “regimental patch” area)

Question 7

which investigations would you do for a shoulder dislocation?

Answer 7

• Xray
• Magnetic resonance arthrography is an MRI scan of the shoulder with a contrast injected into the shoulder joint. This can be used to assess the shoulder for damage (e.g., Bankart and Hill-Sachs lesions) and planning for surgery.
• Arthroscopy involves inserting a camera into the shoulder joint to visualise the structures

Question 8

what is the glenoid labrum and how can it be damaged in shoulder dislocations?

Answer 8

The glenoid labrum surrounds the glenoid cavity. The labrum is a rim of cartilage that creates a deeper socket for the head of the humerus to fit into. When the shoulder dislocates, the labrum can tear along one edge.

Bankart lesions are tears to the anterior portion of the labrum. These occur with repeated anterior subluxations or dislocations of the shoulder.

Hill-Sachs lesions are compression fractures of the posterolateral part of the head of the humerus.

Question 9

what is the acute management of a shoulder dislocation?

Answer 9

Analgesia, muscle relaxants and sedation as appropriate

Gas and air (e.g., Entonox) may be used, which contains a mixture of 50% nitrous oxide and 50% oxygen

A broad arm sling can be applied to support the arm

Closed reduction of the shoulder (after excluding fractures)-> Dislocations associated with a fracture may require surgery

Post-reduction x-rays

Immobilisation for a period after relocation of the shoulder

Question 10

what are ongoing management options?

Answer 10

There is a high risk of recurrent dislocations, particularly in younger patients.

Physiotherapy is recommended to improve the function of the shoulder and reduce the risk of further dislocations.

Shoulder stabilisation surgery may be required to improve stability and prevent further dislocations. This may be an arthroscopic or an open procedure.

Question 11

what is the prognosis after a shoulder dislocation?

Answer 11

There is a prolonged period of recovery and rehabilitation after shoulder stabilisation surgery (3 months or more).

Recurrent instability and dislocations can occur in up to 20% of patients after surgery.