Shoulder dislocation

SHOULDER DISLOCATION IN EMERGENCY MEDICINE DEPARTMENT

1. Shoulder dislocation DR ASHMAL JR,EMERGENCY MEDICINE GMC KANNUR

2. SHOULDER JOINT BALL AND SOCKET JOINT 3 JOINT - Glenohumeral - Acromioclavicular - Sternoclavicular -Very mobile but also very unstable Stabilized by rotator cuff infraspinatus Supraspinatus Teres minor subscapularis

3. Shoulder dislocation is when head of humerus seperates from the scapula at the gleno humeral joint . TYPES OF DISLOCATION Anterior >95 % -sub coracoid (m/c) -sub glenoid -sub clavicular - intra thoracic(L/C) Posterior <2 % ,- young, seizure Inferior <1% ( luxio erecta ) Superior (very rare)

4. RISK FACTORS Age – Bimodal Congenital Activity-95% due to trauma Previous dislocation /trauma PREVENTION Protection of shoulder joint Build up muscle Avoid High risk activity

5. HISTORY History is crucial Mechanism of Injury Postion of arm at time of injury -Anterior- Arm abducted and externally rotated -posterior- Arm adducted and internally rotated - Inferior -Arm fully abducted and elbow oflen flexed on or behind head

6. CLINICAL SIGNS AND SYMPTOMS - LOSS OF NORMAL CONTOUR SEVERER SHOULDER PAIN RANGE OF MOVT DECREASED PALPABLE HUMERAL HEAD NOT ABLE TO TOUCH OPPOSITE SHOULDER APPREHENSION TEST The examiner places arm shoulder in 90 degree of shoulder flexion with elbow flexed to to 90 degree and then internally rotates the arm.positive when patient experience pain with internal rotation

7. Investigations XRAY -Shoulder AP view -Scapular Y view - Axillary view MRI Tendon and ligament injury

8. ShoulderAP and scapular Y view

9. Scapular Y VIEW

10. Anterior dislocation Most common

11. REDUCTION TRACTOIN COUNTER TRACTION KOCHERS TECHNIQUE SIMPSON METHOD HIPPOCRATES METHOD CUNNINGHAM TECHNIQUE MILCHE TECHNIQUE

12. procedural sedation Intra- articular injection of 10 to 20 mL of 1% lidocaine (10 mL provides a total dose of 100 milligrams of lidocaine ). Perform neurovascular examination before and after reduction.

13. The patient is supine with the arm abducted and elbowflexed at 90 degrees. A sheet is tied and placed across the thorax of thepatient and then around the waist of the assistant. Another sheet is tied and placed around the forearm of the patient at the elbow and the waist of physician and give traction

14. Stimpson technique Place the patient prone with the dislocated extsremity hanging over theside of the stretcher and a 10-lb weight attached to the wrist. Complete muscle relaxation is required. Reductionoccurs in 20 to 30 minutes.

15. SCAPULAR MANIPULATION TECHNIQUE The patient is positioned with weights in the same manner as the Stimson technique . After adequate sedation, the physician pushes the tip of the scapula medially using the thumbs, while stabilizingthe superior aspect with the cephalad hand.

16. CUNNINGHAM TECHNIQUE combination of humerus and scapular positioning and specific massage of a spasming biceps muscle

17. MILCH TECHNIQUE The maneuvers for the Milch technique are external rotation, arm abduction to 180 degrees with simultaneous pressure on the humeral head , and in-line longitudinal traction with continued pressure

18. COMPLICATION NERVE-AXILLARY VESSEL- AXILLARY RECURRENCE LIGAMENT INJURY ASSOCIATED FRACTURE - NECK OF HUMERUS - TUBEROSITY - HILLSACH - BANKART

19. BANKARTS LESION

20. HILLSACHS LESION

21. Posterior dislocation TYPES - subacromial,subglenoid , or subspinous prominence of the posterior shoulder and anterior flattening of the normal shoulder contour

22. POSTERIOR

23. Inferior

24. When to refer to orthopedician Inferior or posterior dislocation Fracture+ anterior dislocation not amenable to reduction Recurrent dislocation