Shoulder(gleno-humeral) dislocation

Question 1

which is more common, anterior or posterior shoulder dislocation

Answer 1

anterior

posterior only 2-5% of all

Question 2

what does traumatic anterior shoulder dislocation occur due to

Answer 2

excessive external rotation force or fall onto the back of the shoulder

Question 3

give an example of how dislocations can occur without trauma

Answer 3

due to seizures(look for bilateral dislocation)

Question 4

describe what the Bankart lesion often seen in anterior shoulder dislocation is

Answer 4

the detachment of the anterior glenoid labrum and capsule

Question 5

describe what the Hill-Sachs lesion seen in anterior shoulder dislocations is

Answer 5

when the posterior humeral head impacts on the anterior glenoid producing an impaction fracture of posterior head

Question 6

describe what can happen to the axillary nerve in an anterior shoulder dislocation

Answer 6

can be stretched as it passes through the quadrilateral space

Question 7

what is seen when looking at a patient with a shoulder dislocation

Answer 7

loss of symmetry with loss of roundness of shoulder, and arm held in adducted position supported by the other arm

Question 8

what is the principal sign of axillary nerve injury in shoulder dislocation

Answer 8

loss of sensation in regimental badge area

Question 9

what other shoulder injury is often seen in older patients with shoulder dislocation

Answer 9

rotator cuff tear

Question 10

what investigation is used to diagnose shoulder dislocation

Answer 10

X-ray, sometimes 2 planes useful

Question 11

what fractures can occur with a shoulder dislocation

Answer 11

fracture of surgical neck and fracture of greater tuberosity

Question 12

describe the mainstay of treatment for anterior shoulder dislocations

Answer 12

closed reduction under sedation or anaesthetic, the sling for 2-3 weeks to allow capsule to heal, then physio

Question 13

describe how the management of delayed presentation shoulder dislocations differs from normal

Answer 13

may be unable to do closed reduction, would then need open reduction

Question 14

describe how the risk of recurrent dislocation is predicted

Answer 14

by the age of the patient at the time of the initial dislocation, re-dislocation risk decreases as age increases

Question 15

how are recurrent shoulder dislocations treated

Answer 15

by Bankart repair with reattachment of torn labrum and capsule by arthroscopic or open means

Question 16

describe how a posterior dislocation of the arm is caused

Answer 16

by a posterior force on the adducted and internally rotated arm

Question 17

what is the main X-ray finding for posterior shoulder dislocations

Answer 17

the “light bulb” sign, where the excessively internally rotated humeral head looks symmetrical like a light bulb on AP view

Question 18

what is the mainstay of treatment for posterior shoulder dislocations

Answer 18

closed reduction and period of immobilisation followed by physio

Question 19

how is axillary nerve function tested of a shoulder dislocation

Answer 19

by feeling the regimental badge area of the dislocated side