Shoulder DislocationShoulder Dislocation

Mr. Mubarak M AbdelkerimMr. Mubarak M AbdelkerimConsultant Orthopaedic SurgeonConsultant Orthopaedic Surgeon

MBBS MS MCh Orth FRCSI FRCSEd FRSMMBBS MS MCh Orth FRCSI FRCSEd FRSM

VISIONVISION

• IF YOU CAN IMAGINE IT,YOU CAN ACHIEVE IT.

• IF YOU CAN DREAM IT ,YOU CAN BECOME IT.

Shoulder instabilityShoulder instability

• The glenohumeral joint has little mechanical stability because of

• 1-Its shallow socket and large ball • 2-Extra ordinary range of movement . • This minimal stability achieved by • 1-capsul- labral complex .• 2-glenohumeral ligament • 3- negative intra articular pressure & suction cup

effect of glenoid labrum • 4-dynamic stabilizer (Rotator cuff muscle.

ClassificationClassification

• 1-DISLOCATION / SUBLAXATION

• 2-ACUTE /CHRONIC

• 3-VOLUNTRAY /INVOLUNTORY

• 4-TRAUMATIC/ATRAUMATIC;

Cont.Cont.

1-TUBS(traumatic unilateral Bankart lesion and surgery) torn

losses): generally describe traumatic instability any injury can be

identified –repaired restoring stability .

2- AMBRI (Atraumtic Multidirectional Bilateral Rehabilitation & Inferior capsular shift )(born losses).

Describe the condition in which the joint unstable with out any

Patho- anatomyPatho- anatomy

When the glenohumeral joint dislocates the following injuries can be inflicted:-

1-Bankart lesion: Avulsion of inferior glenohumeral ligaments –the labrum &

the capsular attachment on Antero –inferior aspect of gelnoid rim and is found in most of traumatic ant dislocation

2-Bony Bankart: lesion: soft tissue lesion plus fracture glenoid rim

3-Hill-Sachs lesion Is impaction fracture of humeral head on the glenoid rim

Mechanism of injuryMechanism of injury

1. ANTERIOR DISLOCATION;• Usually following fall on outstretched hand the

humerous driven forward stretching capsule or avulsion the gleniod labrum a typical way is arm abducted and in ext rotation

• 2.POSTEIOR DISLOCATION: . Sever force needed to cause marked adduction &

internal rotation commonly caused during fits & with electric shock. ( Ethanol)

  

DiagnosisDiagnosis • CLINICAL EXAMINATION :• *careful exam should provide an accurate impression

of instability –the asymptomatic shoulder must be examined to establish normal value.

• INSPECTION :• Look for muscle wasting-contracture change in

colour&posture• MOVEMENT:• Active &passive movement should be assessed the

standard plane are flexion –abduction &extension –external rotation with elbow 90 internal rotation when PT reach up his back.

ContinuedContinued

CLINICAL TEST :1-DRAW TEST 2-ANTERIOR APPREHENSION TEST sensitive for ant instability 3-JOBES RELOCATION TEST4-Sulcus Test • FURTHER EXAM – under aid of anaesthesia is

always carried out before surgical stabilizing including draw test assessment of passive &active movement

InvestgationInvestgation

1-X-RAY ANTERIO POSTERIOR VIEW AXILLARY VIEW IS STANDARD *X-ray also need to exclude other injuries2-CT• useful if significant bone damage is suspected 3-M R I is non invasive &can identify most tissue damage 4-ARTHROSCOPY give accurate impression of damage to the joint

Treatment Treatment

1-Careful examination the to axillary and musclo- cutaneous nerve

2-Sedation unless there is fracture or nerve injury general anaesthsia is mandatory

3-Reduction

4-Surgical Treatment

ContinuedContinued

AFTER TREATMENT :• Arm should be in a broad arm sling for 2-6 weeks

• Physiotherapy at sixth weeks

• Full activity at10th week

• Contact sport at fourth month