2. โข BALL AND SOCKET JOINT
3 JOINT
โข -Glenohumeral
โข -Acromioclavicular
โข -Sternoclavicular
โข -Very mobile but also very unstable
Stabilized by rotator cuff
โข infraspinatus
โข Supraspinatus
โข Teres minor
โข subscapularis
3.
4.
5. Shoulder dislocation is when head of humerus
separates from the scapula at the gleno humeral
joint .
TYPES OF DISLOCATION
Anterior >95%
โข -sub coracoid
โข -sub glenoid
โข -sub clavicular
โข - intra thoracic
Posterior <2% ,- young, seizure
Inferior <1% (luxio erecta)
Superior (very rare)
6.
7. RISK FACTORS
โข Age โ Bimodal(15-20y and second 50y age)
โข Congenital
โข Activity-95% due to trauma
โข Previous dislocation /trauma
PREVENTION
โข Protection of shoulder joint
โข Build up muscle
โข Avoid High risk activity
8. HISTORY
History is crucial
โข - Mechanism of Injury
โข - Position of arm at time of injury
1. -Anterior- Arm abducted and externally
rotated
2. -posterior-Arm adducted and internally
rotated
3. - Inferior -Arm fully abducted and elbow
often flexed on or behind head.
9. CLINICAL SIGNS AND SYMPTOMS
โข -LOSS OF NORMAL CONTOUR
โข SEVERER SHOULDER PAIN
โข RANGE OF MOVT DECREASED
โข PALPABLE HUMERAL HEAD
โข NOT ABLE TO TOUCH OPPOSITE SHOULDER
10. APPREHENSION TEST
โข The examiner places arm shoulder in 90
degree of shoulder flexion with elbow flexed
to 90 degree and then internally rotates the
arm.
โข Positive when patient experience pain with
internal rotation
11.
12. โข XRAY
-Shoulder AP view
-Scapular Y view
-Axillary view
MRI
Tendon and ligament injury
20. PROCEDURAL SEDATION
โข Intra-articular injection of 10 to 20 mL of 1%
lidocaine (10 mL provides a total dose of 100
milligrams of lidocaine).
โข Perform neurovascular examination before
and after reduction.
21.
22. REDUCTION
โข The patient is supine with
the arm abducted and
elbowflexed at 90 degrees.
โข A sheet is tied and placed
across the thorax of the
patient and then around
the waist of the assistant.
โข Another sheet is tied and
placed around the forearm
of the patient at the elbow
and the waist of physician
and give traction
23. REDUCTION
โข Place the patient prone
with the dislocated
extsremity hanging over
the side of the stretcher
and a 10-lb weight
attached to the wrist.
โข Complete muscle
relaxation is required.
โข Reduction occurs in 20 to
30 minutes.
25. REDUCTION โข The patient is positioned
with weights in the same
manner as the Stimson
technique .
โข After adequate sedation,
the physician pushes the
tip of the scapula medially
using the thumbs, while
stabilizing the superior
aspect with the cephalad
hand.
SCAPULAR MANIPULATION
TECHENIQUE
