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DR ASHMAL
JR,EMERGENCY MEDICINE
GMC KANNUR
 BALL AND SOCKET JOINT
3 JOINT
-Glenohumeral
-Acromioclavicular
-Sternoclavicular
-Very mobile but also very unstable
Stabilized by rotator cuff
 infraspinatus
 Supraspinatus
 Teres minor
 subscapularis
 Shoulder dislocation is when head of
humerus seperates from the scapula at the
gleno humeral joint .
 TYPES OF DISLOCATION
 Anterior >95%
-sub coracoid (m/c)
-sub glenoid
-sub clavicular
- intra thoracic(L/C)
 Posterior <2% ,- young, seizure
 Inferior <1% (luxio erecta)
 Superior (very rare)
 RISK FACTORS
 Age – Bimodal
 Congenital
 Activity-95% due to trauma
 Previous dislocation /trauma
PREVENTION
Protection of shoulder joint
Build up muscle
Avoid High risk activity
 HISTORY
History is crucial
- Mechanism of Injury
- Postion of arm at time of injury
-Anterior- Arm abducted and externally
rotated
-posterior-Arm adducted and internally
rotated
- Inferior -Arm fully abducted and elbow
oflen flexed on or behind head
 CLINICAL SIGNS AND SYMPTOMS
 -LOSS OF NORMAL CONTOUR
 SEVERER SHOULDER PAIN
 RANGE OF MOVT DECREASED
 PALPABLE HUMERAL HEAD
 NOT ABLE TO TOUCH OPPOSITE
SHOULDER
 APPREHENSION TEST
The examiner places arm shoulder in 90
degree of shoulder flexion with elbow flexed
to to 90 degree and then internally rotates
the arm.positive when patient experience
pain with internal rotation
 XRAY
-Shoulder AP view
-Scapular Y view
-Axillary view
 MRI
Tendon and ligament injury
 REDUCTION
TRACTOIN COUNTER TRACTION
KOCHERS TECHNIQUE
SIMPSON METHOD
HIPPOCRATES METHOD
CUNNINGHAM TECHNIQUE
MILCHE TECHNIQUE
 procedural sedation
 Intra-articular injection of 10 to 20 mL of 1%
lidocaine (10 mL provides a total dose of 100
milligrams of lidocaine).
 Perform neurovascular examination before
and
after reduction.
 The patient is supine with the arm abducted and
elbowflexed at 90 degrees. A sheet is tied and
placed across the thorax of thepatient and then
around the waist of the assistant. Another sheet is
tied and placed around the forearm of the patient
at the elbow and the waist of physician and give
traction
 Place the patient prone with the dislocated
extsremity hanging over theside of the
stretcher and a 10-lb weight attached to the
wrist. Complete muscle relaxation is required.
Reductionoccurs in 20 to 30 minutes.
 The patient is positioned with weights in the
same manner as the Stimson technique . After
adequate sedation, the physicianpushes the
tip of the scapula medially using the thumbs,
while stabilizingthe superior aspect with the
cephalad hand.
 combination of humerus and scapular
positioning and specific massage of a
spasming biceps muscle
 The maneuvers for the Milch technique are
external rotation, arm abduction to 180 degrees
with simultaneous pressure on the humeral
head, and in-line longitudinal traction with
continued pressure
 NERVE-AXILLARY
 VESSEL- AXILLARY
 RECURRENCE
 LIGAMENT INJURY
 ASSOCIATED FRACTURE
- NECK OF HUMERUS
- TUBEROSITY
- HILLSACH
- BANKART
 TYPES - subacromial,subglenoid, or
subspinous
 prominence of the posterior shoulder and
anterior flattening of the normal shoulder
contour
 Inferior or posterior dislocation
 Fracture+
 anterior dislocation not amenable
to reduction
Recurrent dislocation

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Shoulder dislocation

  • 2.  BALL AND SOCKET JOINT 3 JOINT -Glenohumeral -Acromioclavicular -Sternoclavicular -Very mobile but also very unstable Stabilized by rotator cuff  infraspinatus  Supraspinatus  Teres minor  subscapularis
  • 3.
  • 4.
  • 5.  Shoulder dislocation is when head of humerus seperates from the scapula at the gleno humeral joint .  TYPES OF DISLOCATION  Anterior >95% -sub coracoid (m/c) -sub glenoid -sub clavicular - intra thoracic(L/C)  Posterior <2% ,- young, seizure  Inferior <1% (luxio erecta)  Superior (very rare)
  • 6.
  • 7.  RISK FACTORS  Age – Bimodal  Congenital  Activity-95% due to trauma  Previous dislocation /trauma PREVENTION Protection of shoulder joint Build up muscle Avoid High risk activity
  • 8.  HISTORY History is crucial - Mechanism of Injury - Postion of arm at time of injury -Anterior- Arm abducted and externally rotated -posterior-Arm adducted and internally rotated - Inferior -Arm fully abducted and elbow oflen flexed on or behind head
  • 9.  CLINICAL SIGNS AND SYMPTOMS  -LOSS OF NORMAL CONTOUR  SEVERER SHOULDER PAIN  RANGE OF MOVT DECREASED  PALPABLE HUMERAL HEAD  NOT ABLE TO TOUCH OPPOSITE SHOULDER  APPREHENSION TEST The examiner places arm shoulder in 90 degree of shoulder flexion with elbow flexed to to 90 degree and then internally rotates the arm.positive when patient experience pain with internal rotation
  • 10.
  • 11.  XRAY -Shoulder AP view -Scapular Y view -Axillary view  MRI Tendon and ligament injury
  • 12.
  • 13.
  • 14.
  • 15.
  • 16.
  • 17.
  • 18.  REDUCTION TRACTOIN COUNTER TRACTION KOCHERS TECHNIQUE SIMPSON METHOD HIPPOCRATES METHOD CUNNINGHAM TECHNIQUE MILCHE TECHNIQUE
  • 19.  procedural sedation  Intra-articular injection of 10 to 20 mL of 1% lidocaine (10 mL provides a total dose of 100 milligrams of lidocaine).  Perform neurovascular examination before and after reduction.
  • 20.
  • 21.  The patient is supine with the arm abducted and elbowflexed at 90 degrees. A sheet is tied and placed across the thorax of thepatient and then around the waist of the assistant. Another sheet is tied and placed around the forearm of the patient at the elbow and the waist of physician and give traction
  • 22.  Place the patient prone with the dislocated extsremity hanging over theside of the stretcher and a 10-lb weight attached to the wrist. Complete muscle relaxation is required. Reductionoccurs in 20 to 30 minutes.
  • 23.
  • 24.  The patient is positioned with weights in the same manner as the Stimson technique . After adequate sedation, the physicianpushes the tip of the scapula medially using the thumbs, while stabilizingthe superior aspect with the cephalad hand.
  • 25.  combination of humerus and scapular positioning and specific massage of a spasming biceps muscle
  • 26.  The maneuvers for the Milch technique are external rotation, arm abduction to 180 degrees with simultaneous pressure on the humeral head, and in-line longitudinal traction with continued pressure
  • 27.  NERVE-AXILLARY  VESSEL- AXILLARY  RECURRENCE  LIGAMENT INJURY  ASSOCIATED FRACTURE - NECK OF HUMERUS - TUBEROSITY - HILLSACH - BANKART
  • 28.
  • 29.
  • 30.
  • 31.  TYPES - subacromial,subglenoid, or subspinous  prominence of the posterior shoulder and anterior flattening of the normal shoulder contour
  • 32.
  • 33.
  • 34.
  • 35.
  • 36.
  • 37.
  • 38.  Inferior or posterior dislocation  Fracture+  anterior dislocation not amenable to reduction Recurrent dislocation