Shoulder Dislocation Flashcards
What is shoulder dislocation?
Humeral head becomes completely displaced from the glenoid cavity
What is the difference between subluxation and dislocation?
Subluxation
Partial dislocation, humeral head does not fully get displaced and naturally pops back into place
What type of shoulder dislocation is more common and why?
Anterior, more than 90%
Anterior muscular and ligamentous support is much less robust than the posterior aspect
What are the associated causes of posterior shoulder dislocations?
Seizures
Electric shock
High-energy dislocation e.g. car crash
What can happen to the labrum in a shoulder dislocation?
Labrum can tear along one edge
What are Bankart lesions?
Tears to the anterior portion of the labrum
What causes Bankart lesions?
Repeated anterior subluxations or dislocations of the shoulder
What are Hill-Sachs lesions?
Compression fractures of the posterolateral part of the head of the humerus
What causes Hill-Sachs lesions?
Shoulder dislocates anteriorly
Posterolateral part of humeral head impacts anterior rim of glenoid cavity
What happens to shoulder stability in Hill-Sachs lesions?
Humeral head is damaged
Shoulder becomes less stable and increased risk of dislocation
What fractures can occur alongside shoulder dislocations?
Humeral head
Greater tuberosity of the humerus
Acromion
Clavicle
(rotator cuff tears may also occur)
What nerve is commonly damaged in shoulder dislocation or subluxation?
Axillary nerve
C5,C6
How do patients with shoulder dislocation present?
After acute injury
Flattened deltoid
Bulging and palpable humeral head
What it is important to assess patients for with shoulder dislocation?
Fractures
Vascular damage
-Absent pulses
-Prolonged capillary refill
-Pallor
Nerve damage
-Loss of sensation in the regimental badge
What is the apprehension test?
Used to test shoulder instability in the anterior dislocation
Likely positive after previous anterior dislocation or subluxation
When is the apprehension test performed?
After recovery from acute injury
How do you perform the shoulder apprehension test?
Patients will become worried that shoulder will dislocate
What investigations are used for shoulder dislocation?
X-ray
Confirm dislocation
Exclude fractures
Magnetic resonance arthography
MRI with contrast into shoulder joint
Arthroscopy
What is the acute management of shoulder dislocation?
Analgesia
Muscle relaxants
Sedation
Gas and air (Entonox)
Arm sling
Surgery
Closed reduction of the shoulder
Immobilisation
Why does it become harder to relocate the shoulder after time?
Muscle spasms occur increasing risk of neurovascular injury
Who is most at risk of recurrent shoulder dislocation?
Younger patients as they are more active
What ongoing management is recommended?
Physiotherapy
Shoulder stabilisation surgery
What structural problems are corrected in shoulder stabilisation surgery?
Bankart lesions
Tightening the shoulder capsule
Bone graft
Correcting Hill-Sachs lesions (Remplissage procedure)
What is the Latarjet procedure?
Taking a bone graft from the coracoid process to correct a bone injury to the glenoid rim
What do these X-rays show?
