Shoulder Dislocation Flashcards
1
Q
Most common type
A
- Anteroinferior - known as anterior
- Posterior typically caused by seizures/electrocution
2
Q
Anterior dislocation cause
A
- Force applied to extended, abducted and externally rotated humerus
3
Q
Ligaments of shoulder joint
A
- Coracoacromial
- Coracohumeral
- Glenohumeral
CH CA GH
4
Q
Presentation of shoulder dislocation
A
- Painful
- Reduced mobility
- Feeling of instability - reluctant to move
5
Q
Examination of shoulder dislocation
A
- Assymmetry
- Loss of shoulder contours
- Anterior bulge of humerus head
- Abducted and externally rotated in anterior
- Adducted and internally rotated in posterior
6
Q
Assessment of dislocated shoulder
A
- Assess NV status - axillary nerve and suprascapular injuries can occur
- Axillary = loss of normal sensation in regimental badge area and weakness in arm abduction - weakened deltoid muscle
7
Q
Associated injuries of shoulder dislocation
A
- Bony Bankart lesion - fractures of inferior glenoid bone with labrum
- Hill-sachs defect - impaction injuries to the chondral surface of posterior and superior portions of humeral head on glenoid fossa rim
- Fractures of greater tuberosity and surgical neck of humerus
- Soft Bankart lesion - avulsions of anterior glenoid labrum and inferior glenohumeral ligament
- Rotator cuff injuries
- Glenohumeral ligament avulsion
3 bony 3 soft
8
Q
Investigations for shoulder dislocation - imaging
A
- X-rays - trauma shoulder series - at least 2 views of AP, Y scapular, axial views
9
Q
Sign for posterior dislocation
A
- Light bulb sign
10
Q
What imaging to do if patient is over 40?
A
- USS or MRI for associated labral or rotator cuff injuries (more common in this age group)
- Also do if clinical signs to suggest this of course
11
Q
Management shoulder dislocation
A
- Reduce - closed reduction
- Immbolise
- Rehab
12
Q
Method of reduction for shoulder dislocation
A
- Hippocratic - heel indo axilla and pull arm
- Upright - sit up, downward traction on arm and another person rotates scapula
- Prone - hand arm off bed with 5-10kg hanging off arm for traction
13
Q
Analgesia/sedation for reduction
A
- If needed - fentanyl, midazolam, propofol or ketamine can be used
- Manipulation using intra-articular lidocaine if elderly and sedation complex
- UpToDate says do not sedate unless needed
14
Q
Options for treatment if closed reduction unsuccessful for shoulder dislocation
A
- Manipulation under anaesthesia
- Open reduction
- If under 25 should be referred to shoulder surgeon due to high risk of ongoing shoulder issues
15
Q
Associated # with shoulder dislocation management?
A
- Surgery would need to be considered as management option
- Need to be seen by T&O team
