shoulder dislocation and glenohumeral dislocation

1. Akshay Singh

2. The Shoulder is one of the largest and most complex joints in
the body. The Shoulder Joint is formed where the Humerus fits
into the scepula ,like a ball and socket. Other important bones
in the Shoulder include:
 The Acromion
 The Clavicle (collarbone)
 The Coracoid Process
Shoulder has other important structures:
 The Rotator Cuff
 The Bursa
 Labrum

4.  The shoulder is the most commonly
dislocated joint in the body.
 Dislocated shoulders tend to occur more
often in males than in females.
 In men-the peak age is 20-30 years and in
women - 61-80 years

5.  The shoulder joint is called a ball-and-socket
joint. The ball is the rounded top of the bone in
the upper arm (humerus), which fits into the
socket — the cup-shaped outer part of the
shoulder blade.
 When the top of the humerus moves out of its
usual location in the shoulder joint, the shoulder
is said to be dislocated.
 A related injury called a shoulder subluxation
occurs when the top of the humerus is only
partially displaced and not totally out of its
socket

6.  Anterior dislocation(98%)
 Posterior dislocation(2%)
 Inferior dislocation(luxatio erecta)(very
rare)

7.  The top of the humerus is displaced forward,
toward the front of the body.
 This is the most common type of shoulder
dislocation,
 more than 95% of cases.
 In young people, the cause is typically sports-
related.
 In older people, it usually is caused by a fall on an
outstretched arm.

9.  The top of the humerus is displaced toward the
back of the body.
 most likely to be related to seizures and electric
shock.
 Posterior dislocations also can happen because of
a fall on an outstretched arm or a blow to the front
of the shoulder.

10.  The top of the humerus is displaced downward. This
type of shoulder dislocation is the rarest,
 It can be caused by various types of trauma in which
the arm is pushed violently downward.

11.  Pain on affected side
 Holds the injured limb with other hand close to
the trunk
 The shoulder is abducted and the elbow is kept
flexed

13.  Loss of the contour of the shoulder may appear as a step
 Anterior bulge of head of humerus may be visible or palpable
 A gap can be palpated above the dislocated head of the
humerus

14.  Limited ROM
 Dugar’s sign- touch the opposite shoulder by crossing arm in
front of body.
 Ruler’s sign

15.  X-RAY
showS following joint dislocation with or without
fracture.
Gleno-humeral dislocation
Acromio-clavicular joint dislocation
 MRI
Shoulder joint MRI scanning shows details of soft
tissue of bones of the shoulder joint.

17. It is performed to evaluate sensory and motor nerve injury nd
brachial plexus injury
It is performed to rule out following injuries associated with
shoulder joint dislocation :-
 Shoulder Joint Fracture
 Joint haematoma
 Tendon injury and tear
 Ligament tear and injury
Arthroscopy:

18.  Hippocratic method-
Longitudinal traction on the arm and a
counterforce to the axilla, usually with the heel of
the foot.

19.  Stimson technique- The patient's arm is allowed to hang
over the edge of the bed with about 10 pounds of weight
hanging from the wrist
 Kocher's method -involves traction to the elbow with
external rotation of the humerus and adducting the elbow
toward the chest.

20. External rotation- is a modification of the Kocher maneuver,
involves flexing the elbow to 90° and slowly adducting the arm to
the patient's side

21.  Both posterior and anterior dislocation may require surgery if
a tear in the capsule prevents stable reduction or if soft tissue
intervenes to prevent it.
 Primary surgical repair: for young adults who have had acute
traumatic shoulder dislocations and who will continue to be
engaged in demanding physical activity - eg, sports, military.

22.  Fractures of the bone-.
 Hill-Sachs deformity - 75% of anterior shoulder
dislocations.
 Nerve damage
 rotator cuff injuries in older patients.
 Recurrent shoulder dislocation.

23.  Have a full understanding of dislocation
anatomy.
 Risk for long term morbidity.
 Longterm outcome studies are needed
comparing treatment alternatives.

24.  http://www.webmd.com/
 http://www.medscape.com/
 https://www.shoulderdoc.co.uk/
 https://images.google.com/