Shoulder Dislocations

1. Shoulder Dislocations
Ben Savage

2. Objectives
The Shoulder
What is a shoulder dislocation
Types of dislocation
Classification of injury
Risk Factors
Prevention
Clinical Signs and Symptoms
Tests
Treatment
Reduction
Prognosis

3. The Shoulder (anon (b), 2009)
Ball and socket joint
3 joint

Glenohumeral

Acromioclavicular

Sternoclavicular
Very mobile but also very unstable
Stabilised by rotator cuff muscles

Infraspinatus

Supraspinatus

Teres minor

Subscapularis

4. What is a Shoulder Dislocation
Shoulder Dislocation is when the head of
the humerus separates from the scapula at
the glenohumeral joint. (Anon (a), 2009)

5. (Wesley Norman,2009)

6. X-ray shows an anterior dislocation of the shoulder
(ROLANDO REYNA , 2009)

7. Types of Dislocation (ROLANDO REYNA ,
2009)
Anterior - 95%

Sub-coracoid

Sub-glenoid

Sub-clavicular
Posterior - 4%
Inferior - <1%

8. Classification of injury to AC joint (Moira
Davenport et al, 2009)
The Rockwood classification is as follows:
Type I - Minor sprain of AC ligament, intact joint capsule, intact CC
ligament, intact deltoid and trapezius
Type II - Rupture of AC ligament and joint capsule, sprain of CC ligament
but CC interspace intact, minimal detachment of deltoid and trapezius
Type III - Rupture of AC ligament, joint capsule, and CC ligament; clavicle
elevated (as much as 100% displacement); detachment of deltoid and trapezius
Type IV - Rupture of AC ligament, joint capsule, and CC ligament; clavicle
displaced posteriorly into the trapezius; detachment of deltoid and trapezius
Type V - Rupture of AC ligament, joint capsule, and CC ligament; clavicle
elevated (more than 100% displacement); detachment of deltoid and trapezius
Type VI (rare) - Rupture of AC ligament, joint capsule, and CC ligament;
clavicle displaced behind the tendons of the biceps and coracobrachialis

9. Risk Factors
Age – Bimodal peaks
Race – None
Congenital
Activity ~95% due to trauma
Previous dislocation/ trauma

10. Prevention
Protection of shoulder joint
Build up muscles around joint
Don’t take part in high risk activities

11. History (Sharon R Wilson et al 2009)
Hx is crucial.
Mechanism of injury
Position of arm at time of injury

Anterior – arm abducted and externally rotated

Posterior – arm adducted and internally rotated

Inferior – arm fully abducted and elbow often flexed
on or behind head

12. Clinical Signs and Symptoms (Daniel
Marsland et al, 2008)
OE:
Loss of normal contour
Complains of severe shoulder pain
Range of movement decreased in the joint
Palpable humoral head
Positive Apprehension test

13. Tests
USS
X-ray
Duplex scan or arteriogram
MRI

14. Treatment (Daniel Marsland et al, 2008)
PRN analgesia and muscle relaxants
Reduction (with neuro exam pre and post)
Immobilisation of limb for 3-5 day
Rehab physiotherapy
If complex dislocation or recurrent
dislocation consider surgery

15. Reduction
Many different methods
Basic principles (Patricia Rivera et al (b) 2009)
Flex arm to 90 degrees
External rotation of humerus
Contraindications (Patricia Rivera et al (a) 2009)
Subclavicular/ intrathorasic disolcation
Suspicion of major vessel damage. 6P’s
Pale, Pulseless, Unreasonable Pain, Paralysed, Paraesthetic, Perishing
with cold
Fractures

16. Prognosis (Moira Davenport, MD et al 2009)
Approximately 80-94% of patients younger than 20 years
at the time of the initial dislocation have a recurrence.
Of patients younger than 40 years, 26-48% develop
recurrent dislocation.
Dislocation recurs in only 0-10% of patients older than
40 years.
Minor trauma that results in a dislocation is associated
with an 86% recurrence rate.

17. References
Wesley Norman http://home.comcast.net/~wnor/radiographsul.htm
8/2/09
Daniel Marsland and Sabrina Kapoor. p178-180 Crash course 2
nd

edition, Rheumatology and Orthopaedics, 2008
Anon(a). http://en.wikipedia.org/wiki/Dislocated_shoulder 8/2/09
http://newsimg.bbc.co.uk/media/images/41807000/jpg/_41807514_3ru
gby.jpg 8/2/09
Anon(b) http://en.wikipedia.org/wiki/Shoulder 9/2/09
Patricia Rivera et al (a),
http://emedicine.medscape.com/article/109130-overview 9/2/09
Patricia Rivera et al (b),
http://emedicine.medscape.com/article/109130-treatment 9/2/09

18. References
Moira Davenport, MD et al
http://emedicine.medscape.com/article/822269-overview 9/2/09
ROLANDO REYNA M.D. http://www.mskcases.com/index.php?
module=article&view=47 9/2/09
L. Edward Seade, MD http://emedicine.medscape.com/article/93323-
overview 9/2/09
Sharon R Wilson, MD et al
http://emedicine.medscape.com/article/823843-overview 9/2/09

19. Thank you for listening
Any Questions