shoulder dislocation by Mohammed alqadi_١٠٤٢١٩.pptx

Shoulder dislocation

1. Shoulder joint dislocation Done by: mohammed alqadi Supervision by Dr /Ibtissam Al ariqi

2. Shoulder joint dislocation Breef anatomy about shoulder region Incidence Defination Classification Etiology Clinical features Investigation Management Complications

3. Shoulder joint anatomy The shoulder region is mainly composed of : Three bony structures: 1- The Clavicle 2- The Humerus 3- The Scapula

4. Muscles The rotator cuff is a set of four muscles that motor the shoulder joint. These muscles are: - Subscapularis , Supraspinatus , Infraspinatus , and Teres Minor.

5. Bones and Ligaments Glenohumeral ligament Coracohumeral ligament Coracoacromial ligament Coracoclavicular ligament Ligaments

6. Shoulder joint stabilization Connective tissue glenoid labrum: cartilaginous ring, surrounds glenoid fossa increases contact area between head of humerus and glenoid fossa . increases joint stability

7. Shoulder Dislocation The shoulder is the one that most commonly dislocates. factors . . lt is common because: - Shallow glenoid cavity & large head of humerus. - Wide range of shoulder movements. - Lax capsule&weak ligament

8. C ont:.. Dislocation : is displacement of a bone from a joint. Shoulder dislocation : is displacement of the head of the humerus from the glenoid cavity of the scapula at the gleno humeral joint . Shoulder dislocation classification : Anterior dislocation. Posterior dislocation Inferior dislocation    

9. 1-traumatic 2-non-traumatic: a-congenital malformation of the articular surface. b- hyperflexibility of the joint due to laxity of the connective tissue. C_Neuromuscular disorder Causes

10. 1- Anterior dislocation Dislocation forword Mechanism of injury: caused by a fall on the hand. The head of the humerus is driven forward, tearing the capsule and producing avulsion of the glenoid labrum ( Bankart lesion). then the arm drops,bringing the head of humerus to its subcoracoid position. Anterior dislocation subdivisions: Sub coracoid Sub glenoid Sub clavicular

11. Clinical features Symptoms . History of trauma . ( see above ) the humerus is "\ . Pain . . Swelling . . lnability to move the affected limb ( all shoulder movements are limited and painful ).

12. Signs 1. lnspection : - Swelling . - Th e arm appears to take origin from a point just under junction of middle and outer thirds of the clavicle . - Deformity : o The patient holds the injured limb at the etbow by the other hand in position of slight abduction . o Loss of shoulder contour ( flattening ). o Loss of axillary concavity

13. 2. Palpation : - Head is palpable anteriorly ( ln the subcoracoid or subclavicular region ) - Empty space under the acromion ( empty glenoid cavity ). 3. Movemen !. complete limitation of shoulder movements . - Axillary nerve ) Deltoid muscle wasting & sensory loss over its lateral aspect of arm . - Axillary artery )

14. X-Ray AP- Xray will show the humeral head is displaced anteriorly and medially . lateral view Will show the humeral head out of line with the socket.

15. Anterior dislocation treatment Is an emergency we must examine the pulse and nerve It should be reduced in less than 24 hours .Strong analgesics are needed to relive the pain of a dislocation and the anxiety associated with it. ● Some reduction methods need anasthesia apply a sling arm for3-4day . ● A fracture dislocation will probably require surgery. Without a fracture … closed reduction is usually adequate active exercises are start as soon as possible to prevent stiffness of joint.

16. Treatement.(cont) …. Various of methods of reduction: 1) Stimon's technique. 2)Hippocratic method. 3)Kocher's method.

17. Stimon's technique. The patient is left prone with the arm hanging over the side of the bed. After 15 or 20 minutes the shoulder may reduce.

18. Hippocratic methods Traction is applied to the arm with the shoulder is slight abduction while an assistant applied firm counter- tracthion to the body.

19. The heel of the foot is placed against the humeral head in the axilla . And longitudinal traction is applied to the arm .

20. Kocher's method The elbow is bent to 90 and hold close to the body. No traction should be applied . The arm is slowly rotated 75 laterally.The point of the elbow is lefted forward and the arm is rotated medially.

21. Treatement cont.. When the patient is fully awake, active abduction is gently tested to exclude an axillary nerve injury and rotator cuff tear. The median, radial, ulnar and musculocutaneous nerves are also teste and the pulse is felt. The arm is rested in a sling for about three weeks in those under 30 years of age (who are most prone to recurrence) and for only a week in those over 30 (who are most prone to stiffness). Then movements are begun, but combined abduction and lateral rotation must be avoided for at least 3 weeks. Throughout this period, elbow and finger movements are practised every day.

22. Complication Early ……Rotator cuff tear, nerve injury, vascular injury, fracture dislocation. Late ……..Shoulder stiffness, unreduced dislocation, recurrent dislocation.

23. Posterior dislocation of the shoulder: less than 2 per cent of all dislocations around the shoulder. Mechanism of injury Indirect force producing marked internal rotation and adduction(during a fit or convulsion or electric shock) Direct….A fall on to the fixed adductor arm A fall on the outstretched hand.

24. Clinical picture : Usually missed . several well-marked clinical features. arm is held in internal rotation and is locked in that the position. The front of the shoulder looks flat with a prominent coracoid , but swelling may obscure this deformity; seen from above, however, the posterior displacement is usually apparent .

25. X-ray of Posterior shoulder dislocation AP_x -ray shows a head-on projection giving the classic ‘electric light-bulb ’ appearance. The head of the humerus looks abnormal in shape and away from glenoid fossa .

26. Treatment of posterior dislocation The acute dislocation is reduced (usually under general anaesthesia ) By pulling on the arm with the shoulder in adduction. a few minutes are allowed for the head of the humerus to disengage and the arm is rotated laterally while the humeral head is pushed forward. if reduction feels stable the arm is immobilized in sling, otherwise ,the shoulder is held widely abducted and laterally roated in airplane type splint for 3-6week to allow capsule to heal in shortest postion . Complication: Unreduced dislocation Recurrent dislocation subluxation .

27. Inferior shoulder dislocation (luxatio erecta) Mechanism of injury : Caused by sever hyper abduction force .the humeral head is lifted across inferior rim of glenoid cavity with humeral shaft pointing upward . Soft tissue avulsion of capsule , tendon injury &Muscle tearing Fracture of the glenoid or (proximal of humerus damage to brachial plxus & axillary artery . clinical picture: Pt arm locked in full abduction . On examination the humeral head may feel on or below axilla . We must examine pulse and nerve

28. X-ray The humeral shaft is shown in the abducted position with the head sitting below the glenoid .

29. Treatement Reduction by pulling head upward in the line of abducted arm with counter –traction downward over the top of the shoulder. If the humeral head is stuck in soft tissue with soft tissue injury we must do open reduction . We must examin a vascular and nerve befor and after reduction

30. Acromioclavicular joint injuries Occur either: 1- Subluxation ( luxation = dislocation) here the coracoclaviculer ligament is intact. 2- Dislocation : coracoclaviculer ligament is torn Mechanism of injury : A fall on the shoulder with the arm adducted may strain or tear the acromioclavicular ligment and upwards subluxation of the clavicle Clinical y Brusing Tenderness Pain Movement is limited.

31. Treatement subluxation do not require any special treatement .The arm is rested in a sling 1week Dislocation : A well-tried technique is to repair the coracoclavicular lig.and hold the reducd with temporary coracoclavicular screw. Shoulder is rested for 2 weeks and excersie The screw is removed after 8 weeks Complication Rotator cuff syndrome Unreduced dislocation. Ossification of the ligaments Osteoarthritis

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