Shoulder dislocation by Dr Bipul Borthakur

1. Dr. Bipul Borthakur
Professor, Dept. of Orthopaedics, SMCH

2.  Glenohumeral joint – ball and socket type of synovial joint
 Most mobile joint in the body, but compromised in its stability
 Glenoid cavity: shallow; anteverted and inferiorly angulated from
the long axis of the scapula

4.  Labrum: fibrocartilage attached
to the edge of the glenoid.
 Capsule and ligaments: fibrous
capsule, weak point in the inferior
part .
 Rotator cuff: subscapularis,
supraspinatus, infraspinatus and
teres minor
 Bursae: sub-deltoid and sub-
acromial

5.  Capsulolabral complex
 Rotator cuff
 Negative intra-articular pressure
 Synovial fluid adhesion-cohesion

6.  Increased range of movements of shoulder
joint

7.  Factors responsible for shoulder dislocation:
 The shallowness of the glenoid socket
 Extraordinary range of movement
 Underlying conditions like ligamentous laxity, glenoid dysplasia
 Vulnerability of the joint during stressful activities of the upper limb

8. Shoulder dislocation
Anterior dislocation
1. Subcoracoid
2. Subglenoid
3. Infraclavicular
4. Intrathoracic
Posterior dislocation
1. Subacromial
2. Subglenoid
3. Subspinous
Inferior dislocation
Infraglenoid dislocation.
Also known as Luxatio
erecta

9.  Represent 96% of shoulder
dislocation
 Mechanism of injury
 Indirect injury: fall on outstretched
hand with shoulder in Abduction, ER
and extension.
 Direct injury: anteriorly directed
force to the posterior shoulder

10.  Clinical presentation
 Severe pain, inability to move the
upper limb
 Limb will be held in abduction and
external rotation
 On examination
 Loss of normal contour of shoulder –
flattening / squaring of the shoulder
 Prominent acromion process
 Palpable globular mass anteriorly
 DNVD - Regiment badge sign due to
axillary nerve injury

11.  Special tests:
 Vertical circumference of the axilla – increased
 Hamilton ruler test
 Dugas’ test-touch opp shoulder with arm on chest

12.  Pathological lesions around glenohumeral joint
 Bankart’s lesion – avulsion of the labrum off the glenoid rim +/- glenoid rim
fracture (Bony bankart lesion)
 Hill – Sach’s lesion – posterolateral defect caused by glenoid impression on the
humeral head
 Erosion of glenoid rim
 Cause of recurrent dislocation

14.  Investigaions:
 X-ray Anteroposterior and axillary
views - to confirm the diagnosis
 CT scan – to diagnose bony lesions
 MRI – to diagnose ligamentous laxity
and soft tissue injuries
 Arthrography – to evaluate rotator
cuff tears

15.  APView

17.  Treatment: Closed or open reduction
 Closed reduction techniques: under general anesthesia
 Hippocratic technique
 Stimson gravity technique
 Kocher’s maneuver / Traction countertraction technique
 Milch technique
 Scapular manipulation
 Open reduction: Surgical reduction of dislocation
 First time dislocation in young active men
 Soft tissue interposition
 Displaced (>5mm) greater tuberosity fracture and glenoid rim fracture >5mm in size

18. Stimson method

19. Milch method

20. Hippocratic method

21. Kocher method

22.  Post-reduction protocol:
 Repeat X-ray to confirm the reduction
 Immobilize the shoulder using Universal shoulder immobilizer for 3weeks
 Physiotherapy after 3 weeks
 Complications:
 Early:
 Fractures around the joint – Humeral head, GT, glenoid rim, acromion and coracoid
 Soft tissue injuries – Rotator cuff tears, capsular tears
 Neurovascular injuries – axillary artery and nerve, musculocutaneous nerve; usually occurs in
adults
 Late:
 Recurrent dislocation, unreduced dislocation
 Shoulder stiffness due to post-traumatic arthitis

23.  Represent 2% - 4% of shoulder dislocation
 Mechanism of injury:
 Direct or Indirect trauma
 Electric shock or convulsive mechanisms
 Clinical presentation:
 Pain, restricted movements, arm held in internal rotation and adduction
 On examination:
 Palpable mass posterior to the shoulder
 Prominent coracoid process
 Flat shoulder contour, empty glenoid
 DNVD – Axillary nerve

24.  Investigations:
 X-ray shoulder anteroposterior and axillary view
 CT scan – to evaluate any associated fractures
 Treatment: Closed or open reduction
 Complications:
 Early:
 Fractures around the shoulder joint
 Neurovascular injury
 Late:
 Unreduced or recurrent dislocation
 Anterior dislocation – usually results due to
overtightening the posterior structures
Light bulb appearance

25.  Complications:
 Early:
 Fractures around the shoulder joint
 Neurovascular injury
 Late:
 Unreduced or recurrent dislocation
 Anterior dislocation – usually results due to overtightening the posterior structures

26.  Occurs rarely, usually in elderly individuals
 Also known as Luxatio erecta
 Mechanism of injury: Severe hyperabduction force
 Clinical presentation
 Severe pain
 Upper limb held in hyperabduction
 On examination
 Humeral head is palpable on the lateral chest wall or the axilla
 DNVD – injury to brachial plexus and axillary artery are common

27.  Investigations:
 X-ray AP view – diagnostic; look for associated fractures
around the shoulder joint
 MRI – soft tissue injuries
 Treatment: Closed or open reduction
 Complications:
 Rotator cuff avulsions and tear, pectoralis injury
 Proximal humeral fractures
 Neurovascular injury – axillary artery and brachial plexus;
usually recovers after the reduction

28.  In case of any suggestions/Questions kindly
message/contact on
Mob: +919435031719
Email: drbipulborthakur@gmail.com
drbborthakur@rediffmail.com
THANK YOU..