Diagram based topic included types of dislocation/mechanism/treatment/radiograph/management/complications.

1. Presentation on shoulder dislocation
Submitted by
Divya kumari
Bpt 5th sem
UG1888006004
Subject -orthopaedics
and Traumatology- 1
Submitted to
Dr. Anna

2. Anatomy of shoulder joint

4. Shoulder Dislocation
Basically related to
glenohumeral joint.

5. Types
1) anterior dislocation
2) posterior dislocation
3) inferior dislocation
Rarest

6. Anterior (forward). The head of the arm bone
(humerus) is moved forward, in front of the socket
(glenoid). This is the most common type of dislocation
and usually happens when the arm is extended.
Posterior (behind). The head of the arm bone is moved
behind and above the socket. This is an uncommon type
of dislocation that is usually caused by seizures or
electrical shock.
Inferior (bottom). The head of the arm bone is pushed
down and out of the socket toward the armpit. This is
the least common type of dislocation.

7. Introduction
Most unstable large joint

8. Reasons for instability
Shallow glenoid
Extraordinary ROM
Vulnerability of upper limb to injury
Underlying conditions eg.
ligament laxity

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

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

19. Management
Reduction
◦ Closed
◦ Open

20. Traction-countertraction method
Hippocrates method
Stimpson’s technique
Kocher’s technique

21. Traction-countertraction

22. Traction-countertraction

23. Hippocrates Method

24. Hippocrates Method

25. Hippocrates Method

26. Stimpson’s technique

27. 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

29. Bankart lesion – Soft tissue

30. Hill-Sachs lesion

31. Hill-Sachs lesion

32. 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

33. Posterior dislocation
5-10% of shoulder dislocations
Shoulder is in adduction flexion and
internal rotation

34. Mechanism
Indirect
◦ Electric shock
◦ Seizure episode
Direct
◦ Force on the anterior shoulder

36. Shoulder AP view

37. Scapular Y-view

38. Closed Reduction
Traction to adduct arm in the line of
deformity
Gentle lifting of humeral head into the
glenoid fossa

39. Failed closed
Displaced fracture
Recurrence
Large defect
◦ Reverse Hill Sachs

40. Reverse Hill-Sachs

41. Complications
Neurological
◦ Axillary
◦ Nerve to infraspinatus
Vascular
Fractures
Recurrence

42. Inferior Dislocation
Luxatio erecta

43. Mechanism
Hyperabduction force

44. Radiograph

45. Reduction

46. Operative
Buttonholing

47. Complications
◦ Vascular
◦ Ligaments
◦ Fractures

48. Evaluation of recurrent
atraumatic instability
History
◦ Trauma
◦ Sports
◦ Throwing or overhead activities
◦ Voluntary subluxation
◦ “Clunk” or knock

49. Physical
◦ Demonstrate dislocation/subluxation
◦ Laxity tests
◦ Stability tests

50. Management
Conservative
◦ Acute episode
◦ Immobilisation
◦ Physiotherapy – Strengthening exercises
Operative reconstruction
◦ Soft-tissue reconstruction
◦ Bony reconstruction