Shoulder Dislocation

Question 1

What is shoulder dislocation?

Answer 1

Humeral head becomes completely displaced from the glenoid cavity

Question 2

What is the difference between subluxation and dislocation?

Answer 2

Subluxation
Partial dislocation, humeral head does not fully get displaced and naturally pops back into place

Question 3

What type of shoulder dislocation is more common and why?

Answer 3

Anterior, more than 90%

Anterior muscular and ligamentous support is much less robust than the posterior aspect

Question 4

What are the associated causes of posterior shoulder dislocations?

Answer 4

Seizures

Electric shock

High-energy dislocation e.g. car crash

Question 5

What can happen to the labrum in a shoulder dislocation?

Answer 5

Labrum can tear along one edge

Question 6

What are Bankart lesions?

Answer 6

Tears to the anterior portion of the labrum

Question 7

What causes Bankart lesions?

Answer 7

Repeated anterior subluxations or dislocations of the shoulder

Question 8

What are Hill-Sachs lesions?

Answer 8

Compression fractures of the posterolateral part of the head of the humerus

Question 9

What causes Hill-Sachs lesions?

Answer 9

Shoulder dislocates anteriorly

Posterolateral part of humeral head impacts anterior rim of glenoid cavity

Question 10

What happens to shoulder stability in Hill-Sachs lesions?

Answer 10

Humeral head is damaged

Shoulder becomes less stable and increased risk of dislocation

Question 11

What fractures can occur alongside shoulder dislocations?

Answer 11

Humeral head

Greater tuberosity of the humerus

Acromion

Clavicle

(rotator cuff tears may also occur)

Question 12

What nerve is commonly damaged in shoulder dislocation or subluxation?

Answer 12

Axillary nerve

C5,C6

Question 13

How do patients with shoulder dislocation present?

Answer 13

After acute injury

Flattened deltoid

Bulging and palpable humeral head

Question 14

What it is important to assess patients for with shoulder dislocation?

Answer 14

Fractures

Vascular damage
-Absent pulses
-Prolonged capillary refill
-Pallor

Nerve damage
-Loss of sensation in the regimental badge

Question 15

What is the apprehension test?

Answer 15

Used to test shoulder instability in the anterior dislocation

Likely positive after previous anterior dislocation or subluxation

Question 16

When is the apprehension test performed?

Answer 16

After recovery from acute injury

Question 17

How do you perform the shoulder apprehension test?

Answer 17

Patients will become worried that shoulder will dislocate

Question 18

What investigations are used for shoulder dislocation?

Answer 18

X-ray
Confirm dislocation
Exclude fractures

Magnetic resonance arthography
MRI with contrast into shoulder joint

Arthroscopy

Question 19

What is the acute management of shoulder dislocation?

Answer 19

Analgesia
Muscle relaxants
Sedation
Gas and air (Entonox)
Arm sling
Surgery
Closed reduction of the shoulder
Immobilisation

Question 20

Why does it become harder to relocate the shoulder after time?

Answer 20

Muscle spasms occur increasing risk of neurovascular injury

Question 21

Who is most at risk of recurrent shoulder dislocation?

Answer 21

Younger patients as they are more active

Question 22

What ongoing management is recommended?

Answer 22

Physiotherapy

Shoulder stabilisation surgery

Question 23

What structural problems are corrected in shoulder stabilisation surgery?

Answer 23

Bankart lesions

Tightening the shoulder capsule

Bone graft

Correcting Hill-Sachs lesions (Remplissage procedure)

Question 24

What is the Latarjet procedure?

Answer 24

Taking a bone graft from the coracoid process to correct a bone injury to the glenoid rim

Question 25

What do these X-rays show?

Answer 25