shoulder dislocation

Etiology: 1) anterior dislocation - abduction, external rotation or extension of arm 2) posterior dislocation - adduction, internal rotation or flexion of arm Clinical manifestations: 1) anterior dislocation a) inability to externally rotate & abduct humerus b) apprehension 2) posterior dislocation a) inability to externally rotate & abduct humerus b) inability to fully supinate hand with shoulder in forward flexion c) findings subtle & may be missed * evaluate & document neurovascular status of entire arm Radiology: - X-ray of shoulder (AP, lateral & axillary views) a) identify fracture of humerus, clavicle & glenoid fossa (Bankart lesion) b) identify Hill-Sachs lesion of humerus c) confirm suspected dislocation Differential diagnosis: 1) fracture of humerus, clavicle & glenoid fossa 2) combined fracture-dislocation 3) muscular contusion 4) brachial plexopathy 5) acromioclavicular separation Complications: - glenoid labrum tear Management: 1) anterior dislocation a) elevation & internal rotation of humerus while applying pressure to the anterior humeral head b) Stimson maneuver c) double-sheet method 2) posterior dislocation - with patient supine, apply lateral traction with internal rotation followed by external rotation 3) surgical reduction if conservative reduction fails 4) surgical stabilization following reduction in patients with high risk of recurrence 5) prognosis a) acute anterior dislocation (risk of recurrence) 1] < 20 years of age: > 80% 2] > 20 years of age: 25% b) acute posterior dislocation (risk of recurrence) 1] < 40% 2] younger patients more likely to suffer c) chronic dislocation 1] identify voluntary dislocators & educate them 2] much less likely to respond to conservative management 6) pharmaceutical agents -> NSAIDs for analgesia & inflammation 7) activity a) acute, 1st time dislocations -> immobilization for 2-4 weeks, followed by a sling for for comfort for a total of 6 weeks b) shoulder stabilization exercise 1] less tissue damage with dislocation 2] less force required to induce dislocation 8) patient education: proper conditioning 9) follow-up X-rays a) successful relocation b) Bankart or Hill-Sachs lesions 10) physical therapy a) control pain & swelling b) restore range of motion c) restore strength & endurance d) relearn proprioceptive & functional reflexes 11) bracing a) anterior dislocation: -> limits abduction & external rotation b) posterior dislocation: -> no effective bracing

Related

double-sheet method Stimson maneuver

References

Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 817-18