Shoulder dislocation + examination

Question 1

Methods of manual reduction of shoulder dislocations

Answer 1

Kocher’s
Stimson’s
External rotation
Hippocratic

Question 2

Describe Kocher’s method

Answer 2

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

Question 3

Describe hippocratic method

Answer 3

Patient supine

Arm is adducted with fulcrum placed in axilla

Question 4

Describe stimson’s method

Answer 4

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

Question 5

Describe external rotation method

Answer 5

Same as Kocher’s but patient supine

Question 6

Management of shoulder dislocation

Answer 6

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
PT/OT

Question 7

Indications for surgery

Answer 7

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

Question 8

Describe Bankart and Hill-Sachs lesions

Answer 8

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

Question 9

Complications of shoulder dislocations

Answer 9

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

Question 10

What does the drop arm test assess

Answer 10

Rotator cuff tears, particularly supraspinatus

Question 11

Describe drop arm test

Answer 11

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

Question 12

How do you examine function of each rotator cuff muscle

Answer 12

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

Question 13

Tests for shoulder impingement and their general mechanism

Answer 13

Hawkins
Neers

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

Question 14

Describe shoulder impingement

Answer 14

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

Question 15

Describe technique of Neers and Hawkins

Answer 15

Neers: passively abducting shoulder while stabilising scapula

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