The process of dislocation is massively disruptive to the labrum, joint capsule, supporting ligaments, and muscles. The glenoid is augmented by the cartilaginous labrum with additional support from the joint capsule, surrounding ligaments and the muscles of the rotator cuff.
A shoulderx-ray series is sufficient in almost all cases to make the diagnosis, although CT and MR are often required to assess for the presence of subtle fractures of the glenoid rim or ligamentous/tedious injuries respectively. Plain radiograph Anterior and inferior dislocations are usually simple diagnoses, with the humeral head and outline of the glenoid being incongruent.
It is also important to remember to scrutinize the ribs and portion of the lungs and mediastinum included in the film for unexpected findings (e.g. pneumothorax). Think about the soft tissue structures that might be injured, particularly the neurovascular bundle with inferior dislocations.
As a general rule, the shorter the duration of dislocation the fewer complications (size of Hill-Sachs lesion, neurovascular compromise, etc. Early arthroscopy, labial repair and debridement may be of use, especially in young patients with anterior dislocation in which there is a high (up to 85%) rate of recurrence 3.
Shoulder dislocations can also be associated with large rotator cuff tears in the older ages groups. The major morbidity associated with untreated massive rotator cuff tears in this age group requires a clinician to ensure actively that these injuries are not missed.
This can be done by clinical examination, looking for weakness in the rotator cuff muscles or radiologically with ultrasound or MRI. Shoulder pseudodislocation : apparent inferior displacement of the humeral head from capsular distension secondary to a large arthrosis/effusion.
While the hip has a deep pocket, the shoulder also has a socket, but it is much shallower. The makeup of the shoulder consists of a socket joint and a ball.
Because of the way this sets up, the shoulder enjoys a broader range of movement than the hip. It doesn't matter if you hit a patch and fly off of your mountain bike, or you are trying to make the winning catch in baseball, don't be surprised if you end up with a dislocated shoulder.
A shoulder that is obviously out of place Bruising Swelling Great pain Difficulty in moving the joint Numbness and weakness A tingling sensation in neck or arm Spasm of the shoulder muscles If you feel like your shoulder has become dislocated, you should seek medical attention right away.
Don’t try to put it back into the socket, you may end up creating more problems than you already have by damaging the surrounding muscles as well as the blood vessels and nerves. If you can put ice on your shoulder, you may be able to bring down the swelling and eliminate some pain.
The first thing the doctor will do is feel around your shoulder and the socket area to check the swelling, deformity and tenderness. Used to diagnose conditions, this test utilizes an electromagnetic energy beams that are invisible.
They produce images of the bones, organs, and internal tissues on film. External radiation is used to create the images of the body, internal structures, and organs in order to provide a more definitive diagnosis.
The X-rays go through the structures of the body and provide a “negative” with solid areas showing up in white. When you're examined with shoulderdislocationX ray, your doctor will be able to find the proper treatments for you to help the shoulder get back into place.
Reduction This is what is known as putting the dislocated bone back into place. The shoulder should only be reduced, or put back into the socket by a trained professional in the medical field.
You will want to strengthen the muscles in your rotator cuff, so they are better able to support the shoulder and help to prevent another dislocation. Most surgical procedures are performed right after the dislocation if it has been determined there has been any damage to nerves, muscles, tendons or blood vessels.
Posterior Glenohumeral Dislocation : Oblique View (Case courtesy of Dr Henry Knife, Radiopaedia.org. Posterior Glenohumeral Dislocation : Axillary View (Case courtesy of Dr Sigmund Supper, Radiopaedia.org.
Hill Sachs Lesion Impaction fracture of humeral head against glenoid rim Anterior dislocations, Occurs against anterolateral surface Incidence rate 40-90% As high as 100% in recurrent dislocations (Provence 2012) Posterior dislocations Occurs against anterolateral surface (“reverse Hill Sachs lesion”) Incidence 86%.
Be vigilant for concomitant neurovascular injuries and always perform a full neurovascular assessment before and after reduction Carefully review radiographs for posterior dislocations as they may appear “normal” at first glance Be comfortable with multiple reduction techniques. Depending on patient response to initial attempts, procedural sedation may be necessary.
Mat sen FA et al. Principles for the evaluation and management of shoulder instability. Incident of associated injury in posterior shoulder dislocation : Systematic review of the literature.
Patel DN et al. Lunatic erect: Case series with review of diagnostic and management principles. Results of treatment of lunatic erect (inferior shoulder dislocation).
Anterior shoulder dislocation is by far the commonest type of dislocation and usually results from forced abduction, external rotation and extension 1. Broadly speaking, anterior shoulder dislocations occur in a bimodal age distribution.
The first and by far the more prevalent age group are young adult men who have sustained high-energy injuries to the shoulder. The second group is older patients who have been injured with a much lower level of violence.
Anterior shoulder dislocations are usually managed with closed reduction and a period of immobilization (e.g. 6 weeks) to allow adequate capsular healing, although whether this significantly changes the likelihood of recurrent dislocation is not certain 4. The key to successful healing and normal eventual function is a structured course of physical therapy aimed at reducing muscle wasting and maintaining mobility.
Man aster BJ, Dialer DG, May DA et-al. Musculoskeletal imaging, the requisites. Cuts S, Premier M, Drew S. Anterior shoulder dislocation.
Griffith OF, Antonio GE, Tong CW et-al. Anterior shoulder dislocation : quantification of glenoid bone loss with CT. AJR Am J Roentgen.