Dislocations of the shoulder

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shoulder dislocation for undergraduates/PT/OT

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Dislocations of the shoulder

  1. 1. Shoulder DislocationShoulder Dislocation Mr. Mubarak M AbdelkerimMr. Mubarak M Abdelkerim Consultant Orthopaedic SurgeonConsultant Orthopaedic Surgeon MBBS MS MCh Orth FRCSI FRCSEd FRSMMBBS MS MCh Orth FRCSI FRCSEd FRSM
  2. 2. VISIONVISION • IF YOU CAN IMAGINE IT,YOU CAN ACHIEVE IT. • IF YOU CAN DREAM IT ,YOU CAN BECOME IT.
  3. 3. Shoulder instabilityShoulder instability • The glenohumeral joint has little mechanical stability because of • 1-Its shallow socket and large ball • 2-Extra ordinary range of movement . • This minimal stability achieved by • 1-capsul- labral complex . • 2-glenohumeral ligament • 3- negative intra articular pressure & suction cup effect of glenoid labrum • 4-dynamic stabilizer (Rotator cuff muscle.
  4. 4. ClassificationClassification • 1-DISLOCATION / SUBLAXATION • 2-ACUTE /CHRONIC • 3-VOLUNTRAY /INVOLUNTORY • 4-TRAUMATIC/ATRAUMATIC;
  5. 5. Cont.Cont. 1-TUBS(traumatic unilateral Bankart lesion and surgery) torn losses): generally describe traumatic instability any injury can be identified –repaired restoring stability . 2- AMBRI (Atraumtic Multidirectional Bilateral Rehabilitation & Inferior capsular shift )(born losses). Describe the condition in which the joint unstable with out any
  6. 6. Patho- anatomyPatho- anatomy When the glenohumeral joint dislocates the following injuries can be inflicted:- 1-Bankart lesion: Avulsion of inferior glenohumeral ligaments –the labrum & the capsular attachment on Antero –inferior aspect of gelnoid rim and is found in most of traumatic ant dislocation 2-Bony Bankart: lesion: soft tissue lesion plus fracture glenoid rim 3-Hill-Sachs lesion Is impaction fracture of humeral head on the glenoid rim
  7. 7. Mechanism of injuryMechanism of injury 1. ANTERIOR DISLOCATION; • Usually following fall on outstretched hand the humerous driven forward stretching capsule or avulsion the gleniod labrum a typical way is arm abducted and in ext rotation • 2.POSTEIOR DISLOCATION: . Sever force needed to cause marked adduction & internal rotation commonly caused during fits & with electric shock. ( Ethanol)
  8. 8. DiagnosisDiagnosis • CLINICAL EXAMINATION : • *careful exam should provide an accurate impression of instability –the asymptomatic shoulder must be examined to establish normal value. • INSPECTION : • Look for muscle wasting-contracture change in colour&posture • MOVEMENT: • Active &passive movement should be assessed the standard plane are flexion –abduction &extension – external rotation with elbow 90 internal rotation when PT reach up his back.
  9. 9. ContinuedContinued CLINICAL TEST : 1-DRAW TEST 2-ANTERIOR APPREHENSION TEST sensitive for ant instability 3-JOBES RELOCATION TEST 4-Sulcus Test • FURTHER EXAM – under aid of anaesthesia is always carried out before surgical stabilizing including draw test assessment of passive &active movement
  10. 10. InvestgationInvestgation 1-X-RAY ANTERIO POSTERIOR VIEW AXILLARY VIEW IS STANDARD *X-ray also need to exclude other injuries 2-CT • useful if significant bone damage is suspected 3-M R I is non invasive &can identify most tissue damage 4-ARTHROSCOPY give accurate impression of damage to the joint
  11. 11. TreatmentTreatment 1-Careful examination the to axillary and musclo- cutaneous nerve 2-Sedation unless there is fracture or nerve injury general anaesthsia is mandatory 3-Reduction 4-Surgical Treatment
  12. 12. ContinuedContinued AFTER TREATMENT : • Arm should be in a broad arm sling for 2-6 weeks • Physiotherapy at sixth weeks • Full activity at10th week • Contact sport at fourth month

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