The document discusses shoulder dislocation, including the anatomy of the shoulder joint, causes of dislocation, signs and symptoms, types of dislocation, treatment options like closed reduction and surgery, rehabilitation, and complications. The most common type of dislocation is anterior dislocation, which can occur due to falls or impacts and results in the humeral head moving out of the glenoid socket in the front of the shoulder. Treatment depends on the severity of the dislocation and any associated injuries.

1. Shoulder Dislocation
Created by-Vaibhav Kushwaha
Tabish Parkar
Guided By Dr.Hashini Karunadhara

2. Surface Anatomy of Shoulder Joint

3. Muscles in Shoulder Joint

4. Rotator Cuff Muscles
• Supraspinatus(Abduction)
• Infraspinatus(External Rotation)
• Teres Minor (External Rotation)
• Subscapularis(Internal Rotation)

5. Bones in Shoulder Joint

6. Bursae in Shoulder Joint
o Subcoracoid Bursa
o Subacromial Bursa
o Subscapular Bursa

7. Movements of Shoulder Joint
• Flexion
• Extension
• Abduction
• Adduction
• Lateral Rotation
• Medial Rotation
• Horizontal Flexion
• Horizontal Extension
• Circumduction

8. Shoulder Dislocation
• Glenohumeral
Instability is the Inability
to maintain the Humeral
head in the glenoid fossa
• Most unstable large
joint
• Mobility at the expense
of stability

9. Pathology
• The humeral head is stabilized within the
shoulder joint by the glenoid labrum, a fibro-
cartilaginous rim surrounding the glenoid cuff
that is attached to the tendon of the long
head of the biceps muscle.
• A tear or a violent stretch of these structures
causes the exit of the humeral head from the
glenoid, making the shoulder highly unstable.

10. • A shoulder dislocation can be complete or partial.
• In complete dislocation the head of the humerus moves entirely out
of the socket, requiring medical intervention
• whereas in partial dislocation, also named subluxation, the head of
the humerus slips out of the socket only temporarily to often
returning into place spontaneously.
• Both injuries can cause pain, arm weakness and swelling.

11. Reasons for Instability
• Shallow glenoid
• Extraordinary Rotation Of Muscle
• Vulnerability of upper limb to injury
• Underlying conditions eg. ligament laxity

12. 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

13. Clinical Picture
• Pain
• Holds injured limb with other hand close to trunk
• The shoulder is abducted and the elbow is kept
flexed
• Loss of the normal contour of the shoulder
• Anterior bulge of head of humerus may be visible
or palpable
• Empty glenoid socket

14. What causes a dislocated shoulder?
• Sports injuries.
• Accidents, including traffic accidents.
• Falling on your shoulder or outstretched
arm.
• Seizures and electric shocks, which can
cause muscle contractions that pull the
arm out of place.

15. Dislocated shoulder signs and symptoms may
include:
• Severe shoulder pain
• Swelling and bruising of your
shoulder or upper arm
• Numbness and/or weakness in
your arm, neck, hand, or fingers
• Trouble moving your arm
• Your arm seems to be out of place
• Muscle spasms in your shoulder

16. Risk Factors
• A previous shoulder dislocation or subluxation
predisposes to a second episode of the
pathology particularly in young men
(incidence of 80-90%).
• high risk is found in athletes involved in sports
such as football, rugby, hockey and skiing due
to the frequent contact impacts, throwing
activities and falls.
• Congenital conditions causing loosening of the
joints, such as Ehlers-Danlos Syndrome confer
an intrinsic poor stability of the shoulder joint
facilitating the exit of the humeral head.
• Weakness of the muscles around the shoulder
and core muscles due to lack of training can
predispose to a dislocation.
• Incorrect posture and inadequate sporting
technique are all contributing factors to a
shoulder dislocation.

17. Diagnosis
• A shoulder dislocation is diagnosed clinically when
significant pain, alterations in the appearance of
the shoulder anatomy and impaired movement of
the shoulder are present.
• The history of the mechanisms of injury and pre-
existing conditions are discussed with the doctor
and recorded
• Standard X-ray of the shoulder forms the first
diagnostic approach to confirm the type of
humeral head displacement and potentially
associated injuries to the surrounding bones.
• Additional damage to ligaments, vessels and
nerves is diagnosed by clinical examination,
computer tomogram (CT) scans, magnetic
resonance imaging (MRI), ultrasound and nerve
conduction studies.

18. Treatment
• Nonoperative treatment
• Surgical treatment
• Rehabilitation

19. Nonoperative treatment
• closed reduction is performed usually
under anaesthesia in the Emergency
Department.
• It consists of manual reposition the
humeral head in the glenoid using
different methods.
• This is followed by the immobilisation of
the shoulder for approximately four
weeks, aided by local treatment with ice
and/or heat and non-steroidal
antiinflammatory drugs (NSAIDs).
• At a later stage physiotherapy is
recommended.

20. Surgical treatment
• Surgery is performed if a closed reduction is
not successful or when a traumatic
dislocation is associated with injuries to the
labrum (e.g. Superior Labral Tear from
Anterior to Posterior also named SLAP tear) or
glenoid (Bankart lesion), damage of the
humeral head (Hill-Sachs lesion) or the
ligaments of the rotator cuff.
• These secondary pathologies produce
significant shoulder instability and require
surgical repair to prevent further dislocations.
• Various approaches are available including
arthroscopic surgery and open surgery.
• After surgery the shoulder is immobilised for
3-4 weeks prior to commence physical
therapy

21. Rehabilitation
• Physiotherapy is a key form of treatment following a shoulder
dislocation whether or not surgery has occurred. Strengthening the
muscles around the shoulder is essential for supporting the joint
stability provided by the shoulder ligaments. Therapy also aims at
restoring the range of motion of the shoulder following initial
immobilisation. Physiotherapy consists of a number of approaches:
• Use of a sling
• Massage
• Joint mobilisation
• Ice/heat treatment
• Physical exercise (pendular movements)
• Education in sport and daily activities
• Ergonometric postural correction
• Return to sport plan
• In case of persistent pain and/or movement restrictions the patient
can be treated with antiinflammatory treatment (NSAIDs) and local
steroid injection

22. Prevention
• Take care to avoid falls.
• Wear protective gear when you play
contact sports.
• Exercise regularly to maintain
strength and flexibility in your joints
and muscles.

23. Types of Shoulder Dislocation

24. Types of Dislocation of the Shoulder
• Mostly Anterior > 95 % of dislocations
• Posterior dislocation occurs < 5 %
• True Inferior dislocation (luxatio erecta) occurs <1%
• Superior dislocation occurs <1%
• Habitual - Non traumatic dislocation may present as Multi
directional dislocation due to generalized ligamentous laxity
and is Painless

25. Anterior Dislocation
◦ 97% of recurrent dislocations
◦ It is the most common dislocation
◦ cause inability to abduct the arm.
◦ loss in the round contour of the
shoulder.
◦ The most severe cases of anterior
dislocation of the shoulder are
associated with injury to the axillary
artery and the axillary nerve.

26. Anterior Dislocation of Shoulder

27. Posterior Dislocation
o 3% of shoulder dislocations
o caused by an external blow to the
front of the shoulder.
o This type of shoulder dislocation
can be the consequence of a high-
energy trauma and a fall due to
seizures.
o dislocations may also have
concurrent labral or rotator cuff
pathology

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

29. Shoulder APview

30. Shoulder PA or Scapular Y-view

31. Inferior dislocation
• Inferior dislocation is rarely
seen.
• It is also called Luxatio Erecta
• It occurs when the humerus is
displaced below the joint.
• It is caused by a traumatic
impact pushing the shoulder
downwards.

34. Superior dislocation
• Superior dislocation is the least
frequent type of dislocation (1%).
• It occurs when the humeral head is
driven upward through the rotator
cuff.
• It can be associated with fracture of the
humerus, clavicle and acromion.

36. Complications of Shoulder Dislocation arise
in Trauma Condition

37. Complications of Shoulder Dislocation : Early
• Damage to
Axillary Nerve
Axillary Artery
And Ligaments
• Bone - Associated fracture
◦ Neck of humerus
◦ Greater or lesser tuberosity
• Hill Sach lesion
• Bankart lesion

38. Hill-Sachs lesion
o Hill–Sachs lesion, or Hill–Sachs fracture, is
a cortical depression in the posterolateral
head of the humerus.
o It results from forceful impaction of the
humeral head against the anteroinferior
glenoid rim when the shoulder is
dislocated anteriorly.

39. Bankart Lesion
o A Bankart lesion is an injury of the anterior
(inferior) glenoid labrum of the shoulder due to
anterior shoulder dislocation.
o When this happens, a pocket at the front of the
glenoid forms that allows the humeral head to
dislocate into it.

40. Complications of 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

41. Maneouvers
• Traction-countertraction method
• Hippocrates method
• Stimpson’s technique
• Kocher’s technique

42. Traction-countertraction

43. Hippocrates Method
c

44. Stimpson’s technique

45. Reference
• Gray_s Anatomy for Students 3rd Ed
• Moore - Clinically Oriented Anatomy 7th Ed by allmedicalstuff.com
• https://medlineplus.gov/dislocatedshoulder.html
• https://www.physio-pedia.com/Shoulder_Dislocation
• http://pathologies.lexmedicus.com.au/pathologies/shoulder-
dislocation-and-luxation