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Unstable Shoulder Dislocations: Causes, Evaluation and Management

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Dr.A.Mohan krishna
Dr.A.Mohan krishna

This is a short presentation on shoulder instability, biomechanics, pathology, diagnostic modalities, clinical picture and treatment methods available.

Santé & Médecine
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Unstable Shoulder Dislocations around Shoulder Dr.A.Mohan krishna M.S.Ortho., MCh Orth (U.K) Consultant Orthopaedic surgeon Apollo Hospitals, Hyderabad. Consultant Orthopedic surgeon
NORMAL SHOULDER JOINT
BIOMECHANICS Glenoid labrum • Increases depth of cup by 20% Ligaments • Glenohumeral Ligaments • Joint capsule Muscles • Rotatorcuff muscles • Biceps Dynamic • Proprioceptive feedback
static Dynamic Concavity compression Deltoid & biceps Rotator cuff muscles Joint fluid adhesiveness Ligament & capsule Glenoid Labrum Negative intraarticular pressure
BIOMECHANICS The glenohumeral joint will not dislocate as long as the net humeral joint reaction force is directed within the effective glenoid arc
ANTERIOR DISCLOCATION POSTERIOR DISLOCATION MULTIDIRECTIONAL DIRECTION OF DISLOCATION
Congenital Acute traumatic Atraumatic Types of Instability
TUBS Traumatic Unidirectional Bankart Surgery AMBRI Atraumatic Multidirectional Bilateral Rehab Inferior Capsular shift Recurrent Instability
Anterior - 97% of dislocations. - Subcoracoid - Subglenoid - Subclavicular - Intrathoracic Posterior - 3% - Seizures, - Subacromial, - Subglenoid, - Subspinous Direction of Instability
ASSOCIATED INJURIES Bankarts Lesion Hill Sachs Lesion
EVALUATION OF RECURRENTTRAUMATIC INSTABILITY History trauma sports Throwing or overhead activities
EVALUATION OF RECURRENT ATRAUMATIC INSTABILITY Historytrauma Generalised ligament laxity Throwing or overhead activities Voluntary subluxation History of fear of dislocating
Clinical Evaluation Anterior dislocation Abducted and externally rotated Limited internal rotation Loss of rounded contour of shoulder Posterior Dislocation Sling position of Adduction & Internal Rotation Limited External Rotation & Elevation of arm Posterior prominence of shoulder
Clinical Evaluation Laxity tests Drawers test Sulcus test Push -Pull Stability tests Fulcrum Apprehension test JerkTest
INVESTIGATIONS X-Rays Bony bankarts lesion Hill Sach’s lesion MRI Status of soft tissues MR arthrogram Bankarts lesion, SlAP lesions
ANTERIOR DISLOCATION APVIEW SCAPULAR ‘Y’VIEW CLINICAL
POSTERIOR DISLOCATION AP View Axillary View Clinical
GENERALISED LIGAMENT LAXITY
HABITUAL DISLOCATION
CONGENITAL DISLOCATION
MANAGEMENT Closed manipulation and reduction IV Sedation Anesthesia Open reduction Immobilization for 4 to 6 weeks
SHOULDER STRENGTHENING
MANAGEMENT OF RECURRENT ANTERIOR DISLOCATION RECURRENT TRAUMATIC ANTERIOR DISLOCATION Surgical stabilization Open Arthroscopic Poor response to Non Operative treatment ATRAUMATIC INSTABILITY 80% responds to physio Surgical stabilization Capsulorraphy if non operative feels
MULTIDIRECTIONAL INSTABILITY MULTIDIRECTIONAL INSTABILITY Surgery only if non-operative fails Surgery – Capsulorraphy
BANKARTS REPAIR
BANKARTS REPAIR
BRISTOW’S PROCEDURE Coracoid tip along with the conjoined tendon is transferred to the anteroinferior glenoid neck which acts acts like bone block in front of the humeral head.
THANK YOU

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