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Flashcards in Shoulder dislocation + examination Deck (15):

Methods of manual reduction of shoulder dislocations

External rotation


Describe Kocher's method

Bend affected arm 90 degrees at elbow with full adduction against body
Slowly externally rotate until feel resistance
Lift externally rotated arm forwards as far as possible and internally rotate


Describe hippocratic method

Patient supine
Arm is adducted with fulcrum placed in axilla


Describe stimson's method

Give analgesic before attempting
Patient prone with affected arm hanging down in flexion 90 degrees
Apply weight to wrist of affected side
Muscles spasm and eventually relax
Joint reduces spontaneously


Describe external rotation method

Same as Kocher's but patient supine


Management of shoulder dislocation

Manual reduction manoeuvres
X-ray to check position
US if >50 to check rotator cuff muscles for tearing
Broad arm sling so gravity doesn't pull arm down


Indications for surgery

Failure of manual reduction or not tolerated
Chronic shoulder dislocation (manual reduction more likely to fracture)
Fracture requiring ORIF
Rotator cuff tear requiring shoulder replacement


Describe Bankart and Hill-Sachs lesions

Bankart lesion - torn glenoid labrum +/- impaction fracture at glenoid margin
Hill-Sachs lesion - torn glenoid labrum plus indentation fracture of posterolateral humeral head


Complications of shoulder dislocations

Bankart and Hill-Sachs lesions
Recurrent dislocations
Rotator cuff tear
Neurovascular damage


What does the drop arm test assess

Rotator cuff tears, particularly supraspinatus


Describe drop arm test

Passively abduct patients arm to 90 or 180 degrees, supporting arm at the elbow
Warn patient before letting go of their arm
Ask patient to hold arm in that position and slowly adduct their arm fully
Positive for tear if pain, sudden dropping of arm or weakness in maintaining arm position


How do you examine function of each rotator cuff muscle

Supraspinatus - patient abducts arm to 90 degrees and internally rotates (arm straight) and try to push arm down
Infraspinatus and teres minor - patient flexes elbow 90 degrees with elbows at side. Ask patient to externally rotate against resistance
Subscapularis - patient internally rotates shoulder (hands reach as high as possible up back) and tries to push hands away from back against resistance


Tests for shoulder impingement and their general mechanism


Both minimise the subacromial space (between coracoacromial arch and humeral head)


Describe shoulder impingement

Rotator cuff tendons or subacromial bursa can rub against the coracoacromial arch resulting in shoulder pain
Causes are rotator cuff tendinitis or subacromial bursitis respectively


Describe technique of Neers and Hawkins

Neers: passively abducting shoulder while stabilising scapula

Hawkins: abducts shoulder to 90 degrees and then internally rotates shoulder (arm can be straight or bent)