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![Clinical presentation & Physical
examination
• Pain [severe]
• Hold limb with normal limb by side
of body.
• Abduction and external rotation.
• Pt can’t touch apposite shoulder
[Dugar test]](https://image.slidesharecdn.com/shoulderdislocation-180325073115/85/Shoulderdislocation-33-320.jpg)
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Shoulderdislocation
- 1. Orthopedic Conference Peerapon S. 6thYear Medical Cadet Phramongkutklao College of Medicine
- 2. Case ผู้ป่ วยหญิงไทยอายุ 67 ปี อาชีพ แม่บ้าน ภูมิลาเนา นครราชสีมา
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- 4. Present illness 2 hrs.PTA ผู้ป่ วยขี่ MC เฉี่ยวกับ MC เสียหลัก ล้ม ไหล่และแขนซ้ายกระแทก พื้น ปวดไหล่ซ้ายและต้นแขน ซ้าย ขยับไหล่ซ้ายไม่ได้ ไม่มีศีรษะกระแทก พื้น ไม่ สลบ จาเหตุการณ์ได้
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- 6. A : Canspeak, Can flex neck, patent airway ,not tender at posterior midline of neck B : Trachea in midline, equal breath sound, no subcutaneous emphysema C : BP 163/78 mmHg, PR 80/min, no wound , no bleeding D : E4M5V6, pupil 3 mm RTLBE E : tender at Lt. shoulder , limit ROM at Lt. shoulder , no wound
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- 8. A : Nohistory of food and drug allergy M : No current medication P : Underlying : DM , HT , No history of surgery L : Last meal 14.00 E : As present illness Secondary Survey
- 9. Head to ToeExamination
- 10. General appearance : Goodconsciousness, well cooperated HEENT : Not pale conjunctivae, anicteric sclerae, no external wound at face and neck, no abnormal mass, no lympadenopathy Heart : Normal S1S2, no murmur
- 11. Lung Clear ,equal breathsound Abdomen Soft , not tender , no guarding , no rebound Neuro E4V5M6 , pupil 3 mm RTLBE
- 12. Extremities tender, limit ROMshoulder, Ruler and Dugar sign positive , can palpate head of humerus , Pinprick sensory intact Can flex/extend elbow and finger , pinprick sensory intact
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- 16. Left anterior shoulder dislocationwith Greater tuberosity fracture Film X-Ray
- 17. Anatomy of abdomen •Valium 10 mg IV stat • Morphine 4 mg IV stat • Closed reduction • On Lt. arm sling Management
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- 23. • Anterior shoulderdislocation • Posterior shoulder dislocation • Superior shoulder dislocation • Inferior shoulder dislocation Shoulder Dislocation
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- 28. • Most commonshoulder injuries • Mechanism : anteriorly directed force on the arm when the shoulder is abducted and externally rotated • Associated injury –Axillary nerve –Hill Sachs defect –Bony Bankart lesion –Greater tuberosity fracture Anterior shoulder dislocation
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- 33. Clinical presentation &Physical examination • Pain [severe] • Hold limb with normal limb by side of body. • Abduction and external rotation. • Pt can’t touch apposite shoulder [Dugar test]
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- 35. Physical examination • Loadand shift test – Grade I - increased translation, no subluxation – Grade II - subluxation of humeral head to, but over, glenoid rim – Grade III - dislocation of humeral head over glenoid rim • Apprehension sign • Relocation sign
- 36. • Reduction • simpletraction-countertraction is most commonly used. • relaxation of patient with sedation and analgesics. • Immobilization for 3-4 weeks after shoulder dislocation does NOT change the prognosis compared with immediate mobilization Management
- 37. Reduction Maneuvers • MostCommon Techniques –Kocher (71-100%) –External Rotation (78-90%) –Milch (70-89%) –Stimson (91-96%) –Traction/Countertraction –Scapular Manipulation (79-96%)
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- 40. • More misseddiagnosis . • Mechanism : flexed, adducted, and internally rotated arm is a high-risk position. Posterior shoulder dislocation
- 41. Clinical presentation • Internalrotation • Flat front of shoulder • Prominent coracoid • Prominent post aspect of shoulder
- 42. Management • Under GAreduction by pulling arm in adduction to disengage head then lateraly rotate while pushing head anteriorly. • Immobilization in external rotation and abduction for 3 wks.
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