4. Acute Shoulder Dislocations cme ankit.pptx

4. Acute shoulder Dislocations

1. CME on Shoulder Dislocation PRESENTED BY Dr Ankit Mandal Medical officer Bardibas Hospital

2. Subluxation and Dislocation Subluxation- When two joint surfaces are partially separated Dislocation- When two joint surfaces are completely separated and no contact between the surfaces

3. Dislocation is one of the orthopaedics emergency It should be reduced as soon as possible. If not reduced promptly, pathological changes occur, especially around the hip.

4. Dislocation may be associated with damage to articular cartilage, joint capsule, ligaments, and vascularity of the bones These can lead to posttraumatic arthritis

5. Commonest joint to dislocate because of Shallowness of glenoid cavity Extraordinary ROM Joint laxity Types of shoulder dislocation Anterior Posterior inferior

6. Anterior dislocation Mechanism of Injury :-Fall on hand Clinical Features: - Externally rotated arm supported by the opposite hand - Pain/swelling -Inability to touch opposite shoulder (Duga`s test)) -Flattening of deltoid contour -Head of Humerus felt below the clavicle -DNVS: Axillary, Radial nerves, Brachial plexus injury

7. Other tests : - Hamilton ruler test -Callaway`s test

8. X-ray: AP Lateral: Axillary lateral/Scapular Y view

9. In recurrent dislocation or delayed presentation Hill sach`s lesion : depression in posterosuperior part of humeral head Bankart Lesion Anterior tear in glenoiod labrum

10. Treatment: Acute:- traction and closed Reduction Old :- ‘supervised neglect’ – Open reduction Complications: Unreduced dislocation Recurrent dislocation / Instability

11. Treatment: Methods of reduction : Hippocratic method Stimson`s gravity method Kocher`s method Milch`s Method Scapular manipulation method

12. Kocher’s manoeuvre Most commonly performed T-Traction E- External rotation A-Adduction M-Medial Rotation

13. Post Reduction To check DNVS/stability after reduction Xray confirmation of reduction Immobilization for 3 weeks (in patients < 30 yrs ) 1 week (in patients > 30 yrs ) Rehabilitation

14. Indication of surgery If conservative treatment failed Unreduced dislocation of shoulder Fracture dislocation Neglected dislocation Common name of the surgery: Putti- platt operation Bankart's operation Bristow's operation

15. Complications: Early: Rotator cuff tear Nerve injury Vascular injury Fracture-dislocation Late: Shoulder stiffness Unreduced dislocation- requires open reduction Recurrent dislocation- Bankart lesion, Hill sach lesion

16. Posterior dislocation Rare Mechanism: marked internal rotation and adduction of shoulder- during convulsion, electric shock. Fall on the flexed, adducted arm with a direct blow to the front of the shoulder Fall on outstretched arm

17. Clinical Features: Arm held in internal rotation and locked Front of shoulder flat and coracoid flat X-ray : AP- classic ‘electric light-bulb’ appearance - the ‘empty (or Vacuum) glenoid’ sign Lateral/Axillary view required

18. Inferior dislocation - Luxatio Erecta -Rare Mechanism : severe hyperabduction force Severe soft tissue injury: avulsion of capsule and surrounding tendons, rupture of muscles, glenoid or proximal humerus fracture, brachial plexus and axillary artery injury.

19. Clinical Features: Arm fully abducted, head of humerus in or below axilla DNVS X-ray Treatment: Pulling upward in line of abducted arm Open reduction if failed closed attempt Assesment of DNVS

20. References Apley’s system of Orthopaedics and Fractures 9 th edition Essential Orthopaedics Maheshwari & Mhaskar 6 th edition UpToDate ,Wolters Kluwer, Inc Google images

21. Thank you ANY