Unstable Shoulder Dislocations: Causes, Evaluation and Management
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This is a short presentation on shoulder instability, biomechanics, pathology, diagnostic modalities, clinical picture and treatment methods available.
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Unstable Shoulder Dislocations: Causes, Evaluation and Management
- 1. 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
- 3. BIOMECHANICS Glenoid labrum • Increases depth of cup by 20% Ligaments • Glenohumeral Ligaments • Joint capsule Muscles • Rotatorcuff muscles • Biceps Dynamic • Proprioceptive feedback
- 4. static Dynamic Concavity compression Deltoid & biceps Rotator cuff muscles Joint fluid adhesiveness Ligament & capsule Glenoid Labrum Negative intraarticular pressure
- 5. BIOMECHANICS The glenohumeral joint will not dislocate as long as the net humeral joint reaction force is directed within the effective glenoid arc
- 9. Anterior - 97% of dislocations. - Subcoracoid - Subglenoid - Subclavicular - Intrathoracic Posterior - 3% - Seizures, - Subacromial, - Subglenoid, - Subspinous Direction of Instability
- 10. ASSOCIATED INJURIES Bankarts Lesion Hill Sachs Lesion
- 11. EVALUATION OF RECURRENTTRAUMATIC INSTABILITY History trauma sports Throwing or overhead activities
- 12. EVALUATION OF RECURRENT ATRAUMATIC INSTABILITY Historytrauma Generalised ligament laxity Throwing or overhead activities Voluntary subluxation History of fear of dislocating
- 13. 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
- 14. Clinical Evaluation Laxity tests Drawers test Sulcus test Push -Pull Stability tests Fulcrum Apprehension test JerkTest
- 15. INVESTIGATIONS X-Rays Bony bankarts lesion Hill Sach’s lesion MRI Status of soft tissues MR arthrogram Bankarts lesion, SlAP lesions
- 21. MANAGEMENT Closed manipulation and reduction IV Sedation Anesthesia Open reduction Immobilization for 4 to 6 weeks
- 23. 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
- 24. MULTIDIRECTIONAL INSTABILITY MULTIDIRECTIONAL INSTABILITY Surgery only if non-operative fails Surgery – Capsulorraphy
- 25. BANKARTS REPAIR
- 26. BANKARTS REPAIR
- 27. 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.
- 29. THANK YOU