Shoulder Dislocation Flashcards
Most common type
- Anteroinferior - known as anterior
- Posterior typically caused by seizures/electrocution
Anterior dislocation cause
- Force applied to extended, abducted and externally rotated humerus
Ligaments of shoulder joint
- Coracoacromial
- Coracohumeral
- Glenohumeral
CH CA GH
Symptoms of shoulder dislocation
- Painful
- Reduced mobility
- Feeling of instability - reluctant to move
Examination of shoulder dislocation
- Assymmetry
- Loss of shoulder contours
- Anterior bulge of humerus head
- Abducted and externally rotated in anterior
- Adducted and internally rotated in posterior
Assessment of dislocated shoulder
- Assess NV status - axillary nerve and suprascapular injuries can occur
- Axillary = loss of normal sensation in regimental badge area and weakness in arm abduction - weakened deltoid muscle
Associated injuries of shoulder dislocation
- Bony Bankart lesion - fractures of inferior glenoid bone with labrum
- Hill-sachs defect - impaction injuries to the chondral surface of posterior and superior portions of humeral head on glenoid fossa rim
- Fractures of greater tuberosity and surgical neck of humerus
- Soft Bankart lesion - avulsions of anterior glenoid labrum and inferior glenohumeral ligament
- Rotator cuff injuries
- Glenohumeral ligament avulsion
3 bony 3 soft
Investigations for shoulder dislocation - imaging
- X-rays - trauma shoulder series - at least 2 views of AP, Y scapular, axial views
Sign for posterior dislocation
- Light bulb sign
What imaging to do if patient is over 40?
- USS or MRI for associated labral or rotator cuff injuries (more common in this age group)
- Also do if clinical signs to suggest this of course
Management shoulder dislocation
- Reduce - closed reduction
- Immbolise
- Rehab
Method of reduction for shoulder dislocation
- Hippocratic - heel indo axilla and pull arm
- Upright - sit up, downward traction on arm and another person rotates scapula
- Prone - hang arm off bed with 5-10kg hanging off arm for traction
Analgesia/sedation for reduction
- If needed - fentanyl, midazolam, propofol or ketamine can be used
- Manipulation using intra-articular lidocaine if elderly and sedation complex
- UpToDate says do not sedate unless needed
Options for treatment if closed reduction unsuccessful for shoulder dislocation
- Manipulation under anaesthesia
- Open reduction
- If under 25 should be referred to shoulder surgeon due to high risk of ongoing shoulder issues
Associated # with shoulder dislocation management?
- Surgery would need to be considered as management option
- Need to be seen by T&O team
What to do post reduction of shoulder dislocation?
- Repeat x-rays to assess
- Document NV status again
- Immbolise in broad arm sling for 2 weeks with early physio
- Follow up in 4 weeks
How likely is shoulder dislocation to reoccur?
- Younger people - VERY LIKELY, under 20s are almost 100%
- Older - less likely
What does anterior apprehension test examine for?
- Glenohumeral joint stability
- If positive post dislocation = traumatic anterior instability
- Need MRI to assess soft tissues around joint and referral to shoulder surgeon
Investigation if no improvement of axillary nerve function post 6 weeks
- Nerve conduction studies
- Then refer to neuro? surgeons
When is future surgical treatment of shoulder dislocation post reduction considered?
- Recurrent dislocations
- Ongoing shoulder pain
- Joint instability
- Large Hill-Sachs defects
- Large Bankart lesionss (bony)
Complications of shoulder dislocation
- Chronic pain
- Limited mobility
- Stiffness
- Recurrence
- Adhesive capsulitis
- Nerve damage - axillary
- Rotator cuff injuries
- Degenerative joint disease - esp after labrum/cartilage injury
