shoulder dislocations

Question 1

also known as

Answer 1

glen-humeral dislocationa

Question 2

classified as either

Answer 2

traumatic or atraumatic

Question 3

traumatic shoulder dislocations

Answer 3

anterior shoulder dislocations are much more common accounting for 95% of cases while posterior dislocations only account for around 5%

Question 4

why do traumatic anterior shoulder dislocations occur

Answer 4

due to an excessive external rotatory force or falling onto the back of shoulder

Question 5

what do anterior shoulder dislocations often cause

Answer 5

detachment of the anterior glenoid labrum resulting in a bankart lesion

Question 6

what else can anterior shoulder dislocations also cause

Answer 6

the posterior humeral head to impact on the anterior glenoid which causes and importation fracture of the posterior humeral head called a hill-sachs lesion

Question 7

what is a bankart lesion

Answer 7

anterior shoulder dislocation which results in the detachment of the anterior glenoid labrum

Question 8

what is a hill-sacks lesion

Answer 8

fracture of the posterior humeral head due to importation of the posterior humeral head on the anterior glenoid

Question 9

what can anterior shoulder dislocations damage

Answer 9

the axillary nerve as it can be stretched as it passes through the quadrangular space

Question 10

what other structures can be damaged in anterior shoulder dislocations

Answer 10

sometimes can even compress other nerves of the brachial plexus and/or the axillary artery

Question 11

presentation of anterior shoulder dislocation

Answer 11

• loss of symmetry
• loss of roundness of the shoulder
• arm held in adducted position supported by patients unaffected arm

Question 12

what is the principal sign of damage to the axillary nerve

Answer 12

loss of sensation in the regimental badge area

Question 13

what has to be done before and after x-rays so you don’t get sued

Answer 13

neurovascular assessment must be carried out and documented in the notes

Question 14

what is more rare but can occur in anterior shoulder dislocations

Answer 14

fractures of the surgical neck and greater tuberosity of the humerus

Question 15

diagnosis of shoulder dislocations

Answer 15

x-rays

Question 16

management of anterior shoulder dislocations

Answer 16

• closed reduction under sedation or anaesthesia
• neurovascular assessment before and after this procedure
• redo x-rays to confirm reduction
• patient is placed in a sling for 2-3 weeks allowing the capsule to heal and then physiotherapy is commence

Question 17

who sometimes presents with delayed anterior shoulder dislocations

Answer 17

alcoholics

Question 18

whats the issue in delayed presentations of anterior shoulder dislocations

Answer 18

it may be impossible to reduce shoulder using closed reduction so they may need open reduction

Question 19

when would an anterior shoulder dislocation need surgery

Answer 19

• fractures of the greater tuberosity usually resolve with closed reduction but if not then requires an open reduction internal fixation procedure (ORIF)
• fractures of the surgical neck of the humerus nearly always require surgery

Question 20

what is the risk of recurrent dislocation predicted by

Answer 20

the age of the patient at the time of initial dislocation

Question 21

risk of recurrent dislocation in patients under 20

Answer 21

80%

Question 22

risk of recurrent dislocation in patients over 30

Answer 22

20% and this further reduces with age

Question 23

management of recurrent dislocations

Answer 23

bankart repair which involves re-attaching the torn labrum and capsule

Question 24

posterior shoulder dislocations cause

Answer 24

caused by a posterior force on an adducted and internally rotated shoulder, more common in people who have seizures or have been electrocuted

Question 25

in whom may bilateral shoulder dislocations occur

Answer 25

epileptics who have had a seizure

Question 26

how common are posterior shoulder dislocations

Answer 26

much less common than anterior shoulder dislocations and only account for 5% of shoulder dislocations

Question 27

clinically you can... in posterior shoulder dislocations

Answer 27

the humeral head can be palpated posteriorly

Question 28

whats the issue with posterior shoulder dislocations

Answer 28

often misdiagnosed on x-rays as its much less obvious than anterior shoulder dislocations

Question 29

classical x-ray sign in posterior shoulder dislocations

Answer 29

light bulb sign there the excessively internally rotated humeral head looks symmetrical like a light bulb on AP view

Question 30

management of posterior shoulder dislocations

Answer 30

is the same as for anterior shoulder dislocations - x-ray - closed fixation - sling for 2-3 weeks - physiotherapy

Question 31

atraumatic shoulder dislocations

Answer 31

occur in patients with marked ligamentous laxity (familial ligamentous laxity) or due to connective tissue disorder (marfans and ehlers danlos syndrome)

Question 32

what to atraumatic shoulder dislocations tend to be

Answer 32

multi-directional which may or may not be painful

Question 33

what is management of atraumatic shoulder dislocations

Answer 33

physiotherapy to strengthen the rotator cuff muscles

Question 34

in posterior shoulder dislocations what extra x-ray view should you obtain

Answer 34

oblique view