Shoulder Dislocation

Question 1

What is a dislocation?

What is a subluxation?

These both can be combined with a fracture:

• Fracture dislocation
• Fracture subluxation

Answer 1

Dislocation is a loss of continuity between 2 joint surfaces

Partial dislocation with both parts still touching

Question 2

Which way do the majority of dislocations happen - anteriorly or posteriorly

What arm position would likely cause shoulder dislocation if there was a blow to it? - do movement yourself

Answer 2

Anterior

Abducted
Elbow-extended
Externally rotated

May be from fall on an outstretched arm

Question 3

Clinical features:

Bankart lesion - what is torn due to dislocation?

Hill-Sachs lesion - what is damaged due to dislocation?

What nerve may become damaged, causing palsy?

If this nerve is damaged, it causes a lack of sensation under the shoulder region. What is this area called?

What may tear completely which will need complete repair?

Arterial injury can occur even though it is rare. What should be checked before reduction to rule it out?

THEY MAY GO ON TO HAVE AN UNSTABLE JOINT, WHICH IS PRONE TO SUBLUXATION/DISLOCATION!

Answer 3

Glenoid labrum anteriorly

Damage to the humeral head

Axillary nerve

Sargeant’s patch

Rotator cuff tear

Checking the radial pulse

Question 4

Posterior dislocation:

What neurologic event is it associated with?

What does the head of the humerus look like which indicates it is a posterior dislocation?

Answer 4

Seizures

Light bulb sign

Question 5

Imaging - what direction should the XR be done?

Answer 5

AP and lateral before and after reduction

Question 6

Management:

The reduction is done for dislocation.

What should be reexamined? - 3

How long should they keep the shoulder immobilised?

Answer 6

Re-examine sensation, pulses and movement

1 wk (if age >30 as increased risk of stiffness) 
3 wks (if age <30 as increased risk of dislocation)