shoulder dislocations

Question 1

if not managed correctly, what can shoulder dislocations lead to?

Answer 1

chronic joint instability and chronic pain

Question 2

what is the most common type of shoulder dislocation?

Answer 2

anteroinferior

classically caused by force being applied to an extended, abducted and externally rotated humerus

Question 3

what typically causes posterior dislocations?

Answer 3

seizures or electrocution, or through trauma e.g a blow to the anterior shoulder

Question 4

what are the clinical features of a shoulder dislocation?

Answer 4

painful shoulder, reduced mobility and instability.

examination shows asymmetry with contralateral side. loss of shoulder contours e.g flattened deltoid and anterior bulge of head of humerus may be seen.

asses neurovascular status of the arm, especially axillary and supra scapular nerve.

Question 5

what associated bony injuries can occur with shoulder dislocations?

Answer 5

• bony bankart lesions are fractures of anterior inferior glenoid bones, common in those with recurrent dislocations
• hill Sachs lesions and injuries to superior and posterior portions of the humeral head, in 80% of traumatic dislocations
• fractures of greater tuberosity and surgical neck of humerus can also occour

Question 6

what labral, ligamentous and rotator cuff injuries can occur with shoulder dislocations?

Answer 6

• soft banker lesions of anterior labrum and inferior glenohumeral ligament
• glenohumeral ligament avulsion
• rotator cuff injuries in anterior dislocations

Question 7

what investigations would you do for a shoulder dislocation?

Answer 7

plain radiographs in acute setting . trauma shoulder series is required, comprising anterior posterior Y scapular and axial views.

if labral or rotator cuff injuries are suspected, MRI of shoulder may be warranted for further investigation and classification.

Question 8

how a shoulder dislocation managed?

Answer 8

A to E trauma assessment

stabilise any other injuries

reduction, immobilisation and rehabilitation is the method of management.

asses neurovascular pre and post reduction and then put in a broad arm slide g.

physiotherapy will be required to restore ROM and strengthen rotator cuff.

further surgical treatment may be warranted for ongoing shoulder pain, joint instability, large hill Sachs lesions or large bony bankart lesions.