Shoulder dislocation Flashcards
What are the types of shoulder dislocation?
- Glenohumeral
- Acromioclavicular (12%)
- Sternoclavicular (uncommon)
What are the types of glenohumeral dislocations?
- Anterior (95%)
- Posterior (4%)
- Inferior (1%)
- Superior (rare, protected by coracoacromial arch)
What X-rays are required n suspected shoulder dislocation?
Shoulder X-ray from AP and transcapular Y view
What are the risks and complications of shoulder dislocation?
- Axillary nerve injury
- Brachial plexus and radial nerve injury (rare)
- Axillary artery injury
- Rotator cuff tear (common in elderly)
- Hill-Sachs and Bankart Lesions
What is the general management of shoulder dislocation?
- Prompt reduction in ED (patients may require analgesia to relax rotator cuff muscles; check neuromuscular status pre and post)
- Post reduction immobilisation
- Bankart lesions may require surgical asepsis
Clinical signs of anterior shoulder dislocation?
- Outer end of clavicle abnormally tender and prominent
- Often swollen
- Shoulder pain
- Limited ROM
- Loss of shoulder contour and squaring of deltoid contour
- Shoulder externally rotated and abducted
- Palpable subacromial depression and may be able to feel humeral head below coracoid / in axilla
What needs to be checked in shoulder dislocation, why, and what are the signs?
- Axillary nerve
- Runs round surgical neck of humerus so is prone to damage in dislocation and reduction
- Signs: deltoid paralysis, loss of regimental badge sensation
What are Hills-Sachs lesions?
- Impaction fracture of humeral head against anterior glenoid
- Occurs in 35% of anterior dislocations and is a sign of recurrent dislocation
What is a bankart lesion?
- Detachment of anterior inferior labrum +/- avulsion fracture
- Occurs in most significant dislocations and predisposes to future dislocation
Clinical signs of posterior shoulder dislocation?
- Caused by lightning, electrical and seizure injuries
- Arm adducted and internally rotated
- Anterior shoulder squared with prominent coracoid
- Patient resists external rotation and abduction
X-ray signs of posterior shoulder dislocation?
- Lightbulb sign
- Rim sign
- Trough sign
Main features of inferior shoulder dislocation?
- Occurs following force to completely raised arm
- Arm fully abducted in vertical position (often behind patient’s head)
- Humeral head palpable on chest wall
- Highest incidence of axillary neuromvascular damage
Clinical features of AC dislocation or subluxation?
- Fall onto shoulder or FOOSH during rugby
- Outer end of clavicle prominent, tender and swollen
- Reduced ROM
- Loss of shoulder contour
Difference between AC subluxation and dislocation?
AC dislocation involves tearing of coracoclavicular ligament, subluxation does not