Shoulder dislocation Saseendar
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Dislocation of shoulder classification, management; Shoulder dislocation, Anterior shoulder dislocation, Posterior shoulder dislocation, Inferior shoulder dislocation, Luxatio erecta
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Shoulder dislocation Saseendar
- 1. 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
- 2. Synopsis Introduction Definition Types Anterior/ Posterior/ Inferior ◦ Mechanism ◦ Subtypes ◦ Evaluation ◦ Clinical findings ◦ Management ◦ Complications Recurrent
- 3. Introduction Most unstable large joint Mobility at the expense of stability
- 4. Definition Glenohumeral instability is the inability to maintain the humeral head in the glenoid fossa
- 5. Reasons for instability Shallow glenoid Extraordinary ROM Vulnerability of upper limb to injury Underlying conditions eg. ligament laxity
- 6. Directions of instability Anterior ◦ 97% of recurrent dislocations subcoracoid - abd, extension and external rotation subglenoid subclavicular intrathoracic
- 7. Posterior ◦ 3% of recurrent ◦ Seizures, shock, fall on flexed + adducted arm subacromial subglenoid subspinous Inferior Superior Bilateral
- 8. 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
- 9. Mechanism Usually Indirect fall on Abducted and extended shoulder May be Direct when there is a blow on the shoulder from behind
- 10. 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
- 11. Clinical Picture Pain Holds injured limb with other hand close to trunk The shoulder is abducted and the elbow is kept flexed
- 12. 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
- 14. Anterior Shoulder dislocation Usually also inferior
- 15. Radiograph
- 16. Radiograph
- 17. Anterior Dislocation of Shoulder
- 18. 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
- 20. Maneouvers Traction-countertraction method Hippocrates method Stimpson’s technique Kocher’s technique
- 28. Complications of anterior Shoulder Dislocation : Early Nerve – Axillary Artery – Axillary Ligaments Bone - Associated fracture ◦ Neck of humerus ◦ Greater or lesser tuberosity ◦ Hill Sach ◦ Bankart
- 30. Bankart lesion – Soft tissue
- 31. Bankart lesion - Bony
- 34. 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
- 35. Posterior dislocation 5-10% of shoulder dislocations Shoulder is in adduction flexion and internal rotation
- 36. Mechanism Indirect ◦ Electric shock ◦ Seizure episode Direct ◦ Force on the anterior shoulder
- 38. Shoulder AP view
- 39. Scapular Y-view
- 40. Closed Reduction Traction to adduct arm in the line of deformity Gentle lifting of humeral head into the glenoid fossa
- 41. Operative treatment Failed closed Displaced fracture Recurrence Large defect ◦ Reverse Hill Sachs
- 43. Complications Neurological ◦ Axillary ◦ Nerve to infraspinatus Vascular Fractures Recurrence
- 46. Radiograph
- 47. Reduction
- 49. Complications High ◦ Vascular ◦ Neurological ◦ Ligaments ◦ Fractures
- 50. Evaluation of recurrent atraumatic instability History ◦ Trauma? ◦ Sports ◦ Throwing or overhead activities ◦ Voluntary subluxation ◦ “Clunk” or knock ◦ Fear ◦ Hx of dislocations and energy associated
- 51. Physical ◦ Demonstrate dislocation/subluxation ? ◦ Laxity tests ◦ Stability tests
- 53. Management Conservative ◦ Acute episode ◦ Immobilisation ◦ Physiotherapy – Strengthening exercises Operative reconstruction ◦ Soft-tissue reconstruction ◦ Bony reconstruction
- 55. 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 ssaseendar@yahoo.co.in or call at 91-9500366970.