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Shoulder dislocation Saseendar
This document discusses shoulder dislocations, detailing the types (anterior, posterior, inferior), mechanisms, clinical evaluation, and management strategies. It highlights the importance of timely reduction to prevent complications like avascular necrosis and outlines both conservative and operative treatment options for recurrent instability. The content serves as an educational resource for orthopaedic surgery students and emphasizes the need for professional consultation in patient management.
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Shoulder dislocation Saseendar
- 1. Shoulder Dislocation Dr SaseendarS, MS Ortho, DNB Ortho, MNAMS, Dip SICOT(Belgium), FISOC(US), FASM (Sing), Consultant Arthroscopy and Sports Medicine, Chettinad Super Speciality Hospital, Chennai
- 2. Synopsis Introduction Definition Types Anterior/ Posterior/ Inferior ◦Mechanism ◦ Subtypes ◦ Evaluation ◦ Clinical findings ◦ Management ◦ Complications Recurrent
- 3. Introduction Most unstable largejoint Mobility at the expense of stability
- 4. Definition Glenohumeral instability isthe inability to maintain the humeral head in the glenoid fossa
- 5. Reasons for instability Shallowglenoid Extraordinary ROM Vulnerability of upper limb to injury Underlying conditions eg. ligament laxity
- 6. Directions of instability Anterior ◦97% of recurrent dislocations subcoracoid - abd, extension and external rotation subglenoid subclavicular intrathoracic
- 7. Posterior ◦ 3% ofrecurrent ◦ Seizures, shock, fall on flexed + adducted arm subacromial subglenoid subspinous Inferior Superior Bilateral
- 8. Dislocation of theShoulder Mostly Anterior > 95 % of dislocations Posterior Dislocation occurs < 5 % True Inferior dislocation (luxatio erecta) occurs < 1% Habitual - Non traumatic dislocation may present as Multi directional dislocation due to generalized ligamentous laxity and is Painless
- 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
- 14. Anterior Shoulder dislocation Usuallyalso inferior
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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. Maneouvers 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
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- 30. Bankart lesion –Soft tissue
- 31. Bankart lesion -Bony
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- 34. 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
- 35. Posterior dislocation 5-10% ofshoulder dislocations Shoulder is in adduction flexion and internal rotation
- 36. Mechanism Indirect ◦ Electric shock ◦Seizure episode Direct ◦ Force on the anterior shoulder
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- 40. Closed Reduction Traction toadduct arm in the line of deformity Gentle lifting of humeral head into the glenoid fossa
- 41. Operative treatment Failed closed Displacedfracture Recurrence Large defect ◦ Reverse Hill Sachs
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- 43. Complications Neurological ◦ Axillary ◦ Nerveto infraspinatus Vascular Fractures Recurrence
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- 49. Complications High ◦ Vascular ◦ Neurological ◦Ligaments ◦ Fractures
- 50. Evaluation of recurrent atraumaticinstability History ◦ Trauma? ◦ Sports ◦ Throwing or overhead activities ◦ Voluntary subluxation ◦ “Clunk” or knock ◦ Fear ◦ Hx of dislocations and energy associated
- 51. Physical ◦ Demonstrate dislocation/subluxation? ◦ Laxity tests ◦ Stability tests
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- 53. Management Conservative ◦ Acute episode ◦Immobilisation ◦ Physiotherapy – Strengthening exercises Operative reconstruction ◦ Soft-tissue reconstruction ◦ Bony reconstruction
- 55. Information contained inthis presentation are intended for academic purpose only for the students of orthopaedic surgery. The guidelines mentioned cannot be used absolutely for management of patients. I am not responsible for any controversies that arise out of this presentation. For clarifications/ suggestions please contact ssaseendar@yahoo.co.in or call at 91-9500366970.