A 17-year-old male presented with shoulder pain after a football tackle. On exam, he held his right arm externally rotated with anterior shoulder fullness. He likely had an anterior shoulder dislocation, as the humeral head was not properly articulating with the glenoid fossa and was inferior and medial. Reduction techniques were used, followed by immobilization in a sling. Follow-up care included physical therapy, possible ligament repair to prevent recurrence, and treatment of potential injuries like Hill-Sachs or Bankart lesions.
2. ๏ A 17yo male complains of shoulder pain after being
tackled during a football game. On exam, he holds his
right arm close to his body in external rotation with
palpable anterior fullness of his shoulder
3.
4. ๏ Humeral head does not articulate properly with the
glenoid fossa and typically lies inferior and medial
๏ May be associated with a compression fracture of the
humeral head (Hill-Sachs lesion) and/or the glenoid
labrum (Bankart lesion) which may not be visible until
post reduction film
5. ๏ Reduction by various techniques
๏ Immobilization
๏ Place in sling and swath
๏ Obtain post reduction film
๏ Physical therapy and early mobilization to prevent
frozen shoulder
๏ Ortho follow up
๏ Possible ligament repair to prevent recurrent dislocations
๏ Up to 20% will have intra-articular loose bodies,
significant cartilaginous injury leading to persistent pain
6. ๏ History typically of fall on an abducted, externally rotated
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๏
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arm, driving humeral head anteriorly
Most commonly dislocated joint, accounting for 85% of all
dislocations in the body
95% of all shoulder dislocations are anterior
Hill-Sachs lesion in 60% of pts with primary dislocation
Rotator cuff tears present in 50% of pt <40 yo and 80% in
those >60 yo
Occassionally will have nerve damage from traction
(axillary > posterior cord> musculocutaneous)
Recurrent dislocation more common in pts who sustain
initial injury at younger ages 80-90%
13. ๏ Marx J MD; Hockberger R MD; Walls R MD. Rosenโs
emergency medicine. 7th ed.
๏ Simon R; Sherman S; Koenigsknecht S. Emergency
orthopedics: the extremities. 5th ed. McGraw Hill
Publishing.
๏ Wheeless C R III MD. Wheeless textbook of
orthopedics. www.wheelessonline.com.
