Shoulder dislocation presentation made by Dr.Gurudev

1. SHOULDER DISLOCATION
GURUDEV
2201002005
CRRI
MGMCRI

2. RELEVANT ANATOMY
• AKA GLENOHUMERAL JOINT IS A BALL AND SOCKET TYPE OF JOINT, INHERENTLY
UNSTABLE BECAUSE THE ‘BALL’ IS BIG AND THE ‘SOCKET’ IS SMALL AND SHALLOW.
• THE CAPSULE OF THE SHOULDER JOINT IS LAX AND PERMITS FREEDOM OF MOVEMENT.
• STABILIZERS OF THE SHOULDER JOINT ARE:
 DYNAMIC STABILIZERS:
I. ROTATOR CUFF MUSCLES: SUPRASPINATUS, INFRASPINATUS, TERES MINOR AND SUBSCAPULARIS.
II. DELTOID
III. LONG HEAD OF BICEPS
 STATIC STABILIZERS:
I. GLENOID CAPSULE
II. LABRUM
III. GLENOHUMERAL LIGAMENTS- SUPERIOR, MIDDLE AND INFERIOR GLENOHUMERAL.

6. SHOULDER DISLOCATION
• A DISLOCATED SHOULDER CAN OCCUR FROM A
FALL OR BLOW TO THE SHOULDER. THE
SHOULDER'S MOBILITY AND BALL-IN-SOCKET
MECHANISM MAKES IT THE MOST LIKELY
JOINT IN THE BODY TO BECOME DISLOCATED.

9. ANTERIOR DISLOCATION
• MOST COMMON TYPE OF SHOULDER DISLOCATION (90-
98%)
• IN THIS INJURY, THE HEAD OF HUMERUS COMES OUT OF
THE GLENOID CAVITY AND LIES ANTERIORLY.
• SUBTYPES DEPENDING ON POSITION OF THE
DISLOCATED HEAD
• PREGLENOID: THE HEAD LIES IN FRONT OF THE GLENOID.
• SUBCORACOID: THE HEAD LIES BELOW THE CORACOID
PROCESS.
• SUBCLAVICULAR: THE HEAD LIES BELOW THE CLAVICLE.

10. ATTITUDE OF THE LIMB :
 ARM BY THE SIDE OF THE BODY, ABDUCTED AND
EXTERNALLY ROTATED.

12. Features:
Difficulty in adduction and internal rotation.
Flattened shoulder contour.
Humeral head can be palpated in anterior
shoulder just below the subcoracoid area and
clavicle.

14. POSTERIOR DISLOCATION
 IN THIS INJURY, THE HEAD OF THE HUMERUS COMES TO LIE POSTERIORLY
I.E. BEHIND THE GLENOID.
• LESS COMMON THAN ANTERIOR DISLOCATIONS (~ 2% OF SHOULDER
DISLOCATIONS)
• PATIENTS WILL COMMONLY PRESENT WITH THE ARM INTERNALLY ROTATED
AND IN THE ADDUCTED POSITION.
• PATIENT EXPERIENCES PAIN IF ATTEMPTS TO EXTERNALLY ROTATE OR
ABDUCT.
• HUMERAL HEAD CAN BE PALPATED IN POSTERIOR SHOULDER JUST BELOW
THE ACROMION PROCESS
• CLASSICALLY ASSOCIATED WITH CONVULSIVE SEIZURES AND
ELECTROCUTION THOUGH STILL UNCOMMON.

15. ‘LIGHT BULB SIGN’ IS SEEN ON X-RAY AP VIEW

16. INFERIOR DISLOCATION
AKA LUXATIO ERECTA (ERECT DISLOCATION),
IS THE RAREST TYPE OF SHOULDER
DISCLOATION WHERE THE HEAD COMES TO
LIE IN THE SUBGLENOID POSITION.
MECHANISM OF INJURY : HYPER-ABDUCTION
INJURY (ARM BY THE SIDE OF THE HEAD)
CAUSING IMPINGEMENT OF NECK OF
HUMERUS ON THE ACROMION, WHICH LEVERS
THE HUMERAL HEAD OUT INFERIORLY.

17. It takes a strong force, such as a blow to the
shoulder to pull the bones out of place.

18. Extreme rotation can pop the shoulder out of its socket. Contact
sports injuries often cause a dislocated shoulder.

19. Trauma from motor vehicle accidents and
falls are also a common source of
dislocation

20. symptoms of a dislocated shoulder :
•Extreme pain and/or weakness
•Swelling
•Bruising or redness
•Muscle spasms
•Numbness, tingling or weakness in the arm, hand
or fingers
•Immobility of the arm, or difficulty moving it
•Shoulder visibly out of place

21. PATHOLOGICAL CHANGES
BANAKART’S LESION:
 DISLOCATION CAUSES STRIPPING OF THE GLENOID
LABRUM ALONG WITH THE PERIOSTEUM FROM THE
ANTERO-INFERIOR SURFACE OF THE GLENOID AND
SCAPULAR NECK.
 THE HEAD THUS COMES TO LIE IN FRONT OF THE
SCAPULAR NECK, IN THE POUCH THEREBY CREATED.
 IN SEVERE INJURIES, IT MAY BE AVULSION OF A PIECE
OF BONE FROM ANTERO-INFERIOR GLENOID RIM,
CALLED BONY BANKART LESION.
The glenoid labrum is fibrocartilaginous tissue within the
glenoid cavity of the shoulder joint. The purpose of the
glenoid labrum is to provide stability and shock absorption
within the joint.

22. HILL-SACHS LESION:
 THIS IS A DEPRESSION ON THE HUMERAL HEAD IN
ITS POSTERO-LATERAL QUADRANT, CAUSED BY
IMPINGEMENT BY THE ANTERIOR EDGE OF THE
GLENOID ON THE HEAD AS IT DISLOCATES.

24. Dugas’ test: Inability to touch the opposite
shoulder

25. • CALLAWAY’S TEST: INCREASE IN THE GIRTH OF AFFECTED
SHOULDER AS COMPARED TO THE UNAFFECTED SIDE.

26. Hamilton ruler test: Because of flattening of
shoulder, it is possible to place a ruler on the
lateral side of the arm. This touches the acromion
and lateral condyle of the humerus
simultaneously.

27. TREATMENT
TREATMENT OF ACUTE DISLOCATION IS REDUCTION UNDER SEDATION OR GENERAL
ANAESTHESIA, FOLLOWED BY IMMOBILISATION OF THE SHOULDER IN A CHEST-ARM
BANDAGE FOR 3 WEEKS.
AFTER THE BANDAGE, SHOULDER EXERCISES ARE BEGUN.
TECHNIQUES OF REDUCTION:
KOCHER’S MANOEUVRE: (MNEMONIC TEA-I)
T- TRACTION
E- EXT. ROTATION
A- ADDUCTION
I- INT. ROTATION

29. HIIPOCRATES MANOEVURE: IN THIS METHOD THE
SURGEON APPLIES A FIRM AND STEADY PULL ON THE
SEMI-ABDUCTED AR. HE KEEPS HIS FOOT IN THE
AXILLA AGAINST THE CHEST WALL. THE HEAD OF THE
HUMERUS IS LEVERED BACK INTO THE POSITION USING
THE FOOT AS A FULCRUM

30. COMPLICATIONS
EARLY:
o INJURY TO AXILLARY NERVE MAY OCCUR RESULTING IN PARALYSIS OF
THE DELTOID MUSCLE.
o DIAGNOSIS IS CONFIRMED BY ASKING THE PATIENT TO TRY TO ABDUCT
THE SHOULDER.
o TREATMENT IS CONSERVATIVE.
LATE:
o RECURRENCE IS COMMON DUE TO ANATOMICALLY UNSTABLE JOIN
(MARFAN’S SYN.), INADEQUATE HEALING AFTER FIRST DISLOCATION OR
AN EPILEPTIC PATIENT.

31. oTreatment options include:
1.Putti-Platt operation (double breasting of subscapularis tendon
2.Bankart’s operation (the glenoid labrum and capsule are re-
attached to the front of the glenoid rim)
3.Bristow’s operation (Coracoid process along with its attached
muscles, is osteotomized at its base and fixed to lower half of
the anterior margin of glenoid-provides dynamic anterior
support to head of humerus)
4.Arthroscopic Bankart repair

33. REFERENCE
• HTTPS://WWW.NCBI.NLM.NIH.GOV/BOOKS/NBK459125/
• https://orthoinfo.aaos.org/en/diseases--conditions/dislocated-
shoulder/
• https://www.nhs.uk/conditions/dislocated-shoulder/