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Shoulder dislocation
The presentation discusses shoulder dislocation, focusing on the anatomy of the shoulder joint and the three types of shoulder dislocations: anterior, posterior, and inferior. It outlines the causes, clinical features, management strategies, and complications associated with each type. Emphasis is placed on the importance of timely reduction to prevent complications such as avascular necrosis and the management of recurrent instability.
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Shoulder dislocation
- 1. Presentation on shoulderdislocation Submitted by Divya kumari Bpt 5th sem UG1888006004 Subject -orthopaedics and Traumatology- 1 Submitted to Dr. Anna
- 2. Anatomy of shoulderjoint
- 4. Shoulder Dislocation Basically relatedto glenohumeral joint.
- 5. Types 1) anterior dislocation 2)posterior dislocation 3) inferior dislocation Rarest
- 6. Anterior (forward). Thehead of the arm bone (humerus) is moved forward, in front of the socket (glenoid). This is the most common type of dislocation and usually happens when the arm is extended. Posterior (behind). The head of the arm bone is moved behind and above the socket. This is an uncommon type of dislocation that is usually caused by seizures or electrical shock. Inferior (bottom). The head of the arm bone is pushed down and out of the socket toward the armpit. This is the least common type of dislocation.
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- 8. Reasons for instability Shallowglenoid Extraordinary ROM Vulnerability of upper limb to injury Underlying conditions eg. ligament laxity
- 9. Mechanism Usually Indirect fallon Abducted and extended shoulder May be Direct when there is a blow on the shoulder from behind
- 10. 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
- 11. Clinical Picture Pain Holds injuredlimb with other hand close to trunk The shoulder is abducted and the elbow is kept flexed
- 12. Clinical Picture Loss ofthe normal contour of the shoulder - appears as a step Anterior bulge of head of humerus may be visible or palpable Empty glenoid socket
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- 17. Anterior Dislocation ofShoulder
- 18. Management Emergency Should be reducedin < 24 hours or else AVN of head of humerus Immobilised strapped to the trunk for 3-4 weeks and rested in a collar and cuff
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- 20. Traction-countertraction method Hippocrates method Stimpson’stechnique Kocher’s technique
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- 28. Complications of anteriorShoulder Dislocation : Early Nerve – Axillary Artery – Axillary Ligaments Bone - Associated fracture ◦ Neck of humerus ◦ Greater or lesser tuberosity ◦ Hill Sach ◦ Bankart
- 29. Bankart lesion –Soft tissue
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- 32. Complications of anteriorshoulder 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
- 33. Posterior dislocation 5-10% ofshoulder dislocations Shoulder is in adduction flexion and internal rotation
- 34. Mechanism Indirect ◦ Electric shock ◦Seizure episode Direct ◦ Force on the anterior shoulder
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- 38. Closed Reduction Traction toadduct arm in the line of deformity Gentle lifting of humeral head into the glenoid fossa
- 39. Failed closed Displaced fracture Recurrence Largedefect ◦ Reverse Hill Sachs
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- 41. Complications Neurological ◦ Axillary ◦ Nerveto infraspinatus Vascular Fractures Recurrence
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- 48. Evaluation of recurrent atraumaticinstability History ◦ Trauma ◦ Sports ◦ Throwing or overhead activities ◦ Voluntary subluxation ◦ “Clunk” or knock
- 49. Physical ◦ Demonstrate dislocation/subluxation ◦Laxity tests ◦ Stability tests
- 50. Management Conservative ◦ Acute episode ◦Immobilisation ◦ Physiotherapy – Strengthening exercises Operative reconstruction ◦ Soft-tissue reconstruction ◦ Bony reconstruction