Shoulder dislocation- M.B.B.S

1. Shoulder Dislocation

2. Introduction
 Commonest joint to dislocate
 More common in adults and is rare in children
 Anterior dislocation more common than
posterior disclocation

3. DEFINITION
Broad term used for shoulder problems where head of humerus
is not stable in the glenoid.
Pain occurs due to stretching of the stretching of the capsule ,
as the head moves out in some direction actually without
dislocating
SHOULDER INSTABILITY

4. MECHANISM
 Usually Indirect fall on an outstretched arm with
shoulder abducted and externally rotated
 May be Direct when there is a blow on the shoulder
from behind .
 Direct blow on the front of the shoulder- posterior
dislocation

5.  Classification

6. Anterior:
 Subcoracoid (anterior):
 Humeral head sits anterior and medial to the
glenoid, just inferior to the coracoid.
 ~ 60% of cases.
 PREGLENOID: Head lies in front of the
glenoid.
 SUBCLAVICULAR
: Head lies below the clavicle

7. Other
 POSTERIOR:
 Different mechanisms: seizure, electrocution.
 Present with flattened anterior shoulder and prominent coracoid.
 Can easily go unrecognised.
 INFERIOR: ‘luxation erecta’
 Rare type, the head comes to lie in the the subglenoid position

8. PATHOLOGICAL CHANGES
1. BANKARTS LESION
Involves stripping of the glenoid labrum with the
periosteum from the antero inferior surface of
the glenoid and scapular neck

9. Bankart lesion – Soft tissue

10. HILL SACHS Lesion
Depression on the humeral head in its postero lateral
quadrant due to the impringement by ant edge of glenoid
on the head as it dislocates.

11.  Rounding off of the ant glenoid rim in chronic cases
 There may be associated injuries like fracture of
greater tuberosity , rotator cuff tear etc..

12. CLINICAL PICTURE
 Pain
 Holds injured limb with other hand close to trunk
 The shoulder is abducted and the elbow is kept FLEXED

13. CLINICAL PICTURE
…. Loss of the normal contour of the shoulder - appears as a step
 Anterior bulge of head of humerus may be visible or palpable
 Empty glenoid socket

14. SIGNS
 DUGAS TEST: Inability to touch the opposite
shoulder
 HAMILTON TEST: Due to flattening of the shoulder it
is possible to place a ruler on the lateral side of the
arm.

15. Treatment
 Treatment of acute dislocation is reduction
under sedation or general anaesthasia ,
followed by immoblisation of the shoulder in a
chest arm bandage for three weeks . After the
bandages are removed exercises are begun.

16. Techniques of reduction of
Shoulder Dislocation

17. Hippocrates Method

18. Stimson technique
The patient is placed
prone on the
stretcher with the
affected shoulder
hanging off the edge.
Weights (10-15 lbs)
are fastened to the
wrist to provide
gentle, constant
traction.

19. Kocher”s Manoevre

20. COMPLICATIONS
 Early complications - Axillary nerve injury
 Regiment badge palsy
 Loss of sensation over deltoid
 Abduction of shoulder not possible
 Late complications - Recurrent dislocations

21. THANK YOU