Shoulder

Question 1

What are 4 reduction methods for anterior shoulder dislocation

Answer 1

1. Scapular manipulation
2. External rotation
3. Milch - after external rotation, abduct and pressure in axilla on humeral head
4. Stimson (prone with weight for traction)
   traction/countertraction
5. Cunningham (massage deltoids with gentle downward traction, patient shrugs shoulders back and moves scapula medially)

Question 2

What are 5 complications of shoulder dislocation

Answer 2

Recurrent dislocation
Instability
Nerve injury - axillary or musculocutaneous
Fracture - Hill Sachs lesion or Bony Bankart, greater tuberosity
Labral tear
Vascular injury (axillary)

Question 3

What is a Hill Sachs lesion?

Answer 3

Bony deformity in the head of the humerus from impaction against the glenoid during dislocation

Question 4

What is a Bankart lesion?

Answer 4

Avulsion of the labrum (non bony) or glenoid (bony) during dislocation
Labral tear&raquo_space;> bony bankart in younger individuals

Question 5

What is a reverse Hill Sachs lesion

Answer 5

In posterior shoulder dislocations, an impaction fracture on the anteromedial humeral head

Question 6

What is a contraindication to closed reduction of shoulder dislocations?

Answer 6

Fracture through the surgical neck of the humerus

Obtain orthopedic consultation

Question 7

What is the mechanism of injury for an anterior shoulder dislocation (3)

Answer 7

1. indirect trauma with shoulder in abduction, extension and external rotation
2. direct impaction forces to posterior shoulder
3. convulsive mechanism (seizure, electric shock)

Question 8

What is the mechanism of injury for a posterior shoulder dislocation

Answer 8

1. indirect trauma with shoulder in adduction, flexion and internal rotation
2. Electric shock or convulsive mechanism

Question 9

How do posterior shoulder dislocations present?

Answer 9

Often missed injury
Typically held in traditional sling position of shoulder internal rotation and adduction

Best visualized on axillary Xray view

Question 10

What is the mechanism of inferior glenohumeral dislocation? What population do we see this in?

Answer 10

Hyperabduction force with impingement of the neck of the humerus on the acromion
- levers the humeral head out inferiorly

Elderly patients

Question 11

What is another name for inferior glenohumeral dislocation

Answer 11

Luxatio Erecto

Question 12

What is inferior glenohumeral dislocation usually associated with?

Answer 12

Neurovascular compromise

Often recovers after reduction

Question 13

How do patients with inferior glenohumeral dislocation present?

Answer 13

“Salute” position

Humerus locked in 110-160 degrees of abduction and forward elevation