Mr. Mubarak M Abdelkerim discusses shoulder dislocations and instability. The glenohumeral joint has little stability due to its anatomy. Dislocations can be classified as acute/chronic, voluntary/involuntary, and traumatic/atraumatic. Diagnosis involves clinical examination including special tests as well as imaging like x-rays and MRI. Treatment may involve closed reduction, followed by surgical repair if indicated to address injuries like Bankart lesions. Post treatment includes sling immobilization and gradual physiotherapy.

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. VISIONVISION
• IF YOU CAN
IMAGINE IT,YOU
CAN ACHIEVE IT.
• IF YOU CAN
DREAM IT ,YOU
CAN BECOME IT.

7. 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.

10. ClassificationClassification
• 1-DISLOCATION / SUBLAXATION
• 2-ACUTE /CHRONIC
• 3-VOLUNTRAY /INVOLUNTORY
• 4-TRAUMATIC/ATRAUMATIC;

12. 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

14. 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

16. 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)

18. 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.

19. 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

20. 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

21. 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

22. 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