shoulder dislocation saseendar
DESCRIPTION
Dislocation of shoulder classification, management; Shoulder dislocation, Anterior shoulder dislocation, Posterior shoulder dislocation, Inferior shoulder dislocation, Luxatio erectaTRANSCRIPT
Shoulder Dislocation
Dr Saseendar S, MS Ortho, DNB Ortho, MNAMS,
Dip SICOT(Belgium), FISOC(US), FASM (Sing),
Consultant Arthroscopy and Sports Medicine,
Chettinad Super Speciality Hospital,
Chennai
Synopsis
Introduction
Definition
Types
Anterior/ Posterior/ Inferior◦ Mechanism
◦ Subtypes
◦ Evaluation
◦ Clinical findings
◦ Management
◦ Complications
Recurrent
Introduction
Most unstable large joint
Mobility at the expense of stability
Definition
Glenohumeral instability is the inability
to maintain
the humeral head in
the glenoid fossa
Reasons for instability
Shallow glenoid
Extraordinary ROM
Vulnerability of upper limb to injury
Underlying conditions eg. ligament
laxity
Directions of instability
Anterior
◦ 97% of recurrent dislocations
subcoracoid - abd, extension and external
rotation
subglenoid
subclavicular
intrathoracic
Posterior◦ 3% of recurrent
◦ Seizures, shock, fall on flexed + adducted arm
subacromial
subglenoid
subspinous
Inferior
Superior
Bilateral
Dislocation of the Shoulder
Mostly Anterior > 95 % of dislocations
Posterior Dislocation occurs < 5 %
True Inferior dislocation (luxatio erecta) occurs < 1%
Habitual - Non traumatic dislocation may present as Multi directional dislocation due to generalized ligamentous laxity and is Painless
Mechanism
Usually Indirect fall on Abducted and
extended shoulder
May be Direct when there is a blow
on the shoulder from behind
Pathoanatomy of dislocation
Stretching/ tearing of capsule
Avulsion of glenohumeral ligaments
usually off the glenoid
Labral injury
◦ Bankart lesion
Impression fracture
◦ Hill-Sach lesion
Rotator cuff tear
Clinical Picture
Pain
Holds injured limb with
other hand close to
trunk
The shoulder is
abducted and the elbow
is kept flexed
Clinical Picture
Loss of the normal
contour of the shoulder -
appears as a step
Anterior bulge of head
of humerus may be
visible or palpable
Empty glenoid socket
Anterior Shoulder dislocation
Usually also inferior
Radiograph
Radiograph
Anterior Dislocation of Shoulder
Management
Emergency
Should be reduced in < 24 hours or
else AVN of head of humerus
Immobilised strapped to the trunk for
3-4 weeks and rested in a collar and
cuff
Management
Reduction◦ Closed
◦ Open
Maneouvers
Traction-countertraction method
Hippocrates method
Stimpson’s technique
Kocher’s technique
Traction-countertraction
Traction-countertraction
Hippocrates Method
Hippocrates Method
Hippocrates Method
Stimpson’s technique
Kocher’s Technique
Complications of anterior Shoulder
Dislocation : Early
Nerve – Axillary
Artery – Axillary
Ligaments
Bone - Associated fracture
◦ Neck of humerus
◦ Greater or lesser tuberosity
◦ Hill Sach
◦ Bankart
Axillary nerve injury
Bankart lesion – Soft tissue
Bankart lesion - Bony
Hill-Sachs lesion
Hill-Sachs lesion
Complications of anterior shoulder
Dislocation : Late
Avascular necrosis of the head of the Humerus (high risk with delayed reduction)
Heterotopic calcification ( used to be called Myositis Ossificans )
Recurrent dislocation
Posterior dislocation
5-10% of shoulder dislocations
Shoulder is in adduction flexion and
internal rotation
Mechanism
Indirect
◦ Electric shock
◦ Seizure episode
Direct
◦ Force on the anterior shoulder
Shoulder AP view
Scapular Y-view
Closed Reduction
Traction to adduct arm in the line of
deformity
Gentle lifting of humeral head into the
glenoid fossa
Operative treatment
Failed closed
Displaced fracture
Recurrence
Large defect
◦ Reverse Hill Sachs
Reverse Hill-Sachs
Complications
Neurological
◦ Axillary
◦ Nerve to infraspinatus
Vascular
Fractures
Recurrence
Inferior Dislocation
Luxatio erecta
Mechanism
Hyperabduction force
Radiograph
Reduction
Operative
Buttonholing
Complications
High
◦ Vascular
◦ Neurological
◦ Ligaments
◦ Fractures
Evaluation of recurrent
atraumatic instability
History
◦ Trauma?
◦ Sports
◦ Throwing or overhead activities
◦ Voluntary subluxation
◦ “Clunk” or knock
◦ Fear
◦ Hx of dislocations and energy associated
Physical
◦ Demonstrate dislocation/subluxation ?
◦ Laxity tests
◦ Stability tests
Generalised ligament laxity
Management
Conservative
◦ Acute episode
◦ Immobilisation
◦ Physiotherapy – Strengthening exercises
Operative reconstruction
◦ Soft-tissue reconstruction
◦ Bony reconstruction
Information contained in this presentation are intended for academic purpose only for the students of orthopaedic surgery.
The guidelines mentioned cannot be used absolutely for management of patients.
I am not responsible for any controversies that arise out of this presentation.
For clarifications/ suggestions please contact [email protected] or call at 91-9500366970.