shoulder dislocation

^[1]

Etiology

anterior dislocation
- inability to externally rotate & abduct humerus
- apprehension
posterior dislocation
- inability to externally rotate & abduct humerus
- inability to fully supinate hand with shoulder in forward flexion
- findings subtle & may be missed

* evaluate & document neurovascular status of entire arm

anterior dislocation
- elevation & internal rotation of humerus while applying pressure to the anterior humeral head
- Stimson maneuver
- double-sheet method
posterior dislocation
- with patient supine, apply lateral traction with internal rotation followed by external rotation
surgical reduction if conservative reduction fails
surgical stabilization following reduction in patients with high risk of recurrence
prognosis
- acute anterior dislocation (risk of recurrence)
  - < 20 years of age: > 80%
  - > 20 years of age: 25%
- acute posterior dislocation (risk of recurrence)
  - < 40%
  - younger patients more likely to suffer
- chronic dislocation
  - identify voluntary dislocators & educate them
  - much less likely to respond to conservative management
pharmaceutical agents
- NSAIDs for analgesia & inflammation
activity
- acute, 1st time dislocations
  - immobilization for 2-4 weeks, followed by a sling for for comfort for a total of 6 weeks
- shoulder stabilization exercise
  - less tissue damage with dislocation
  - less force required to induce dislocation
patient education: proper conditioning
follow-up X-rays
- successful relocation
- Bankart or Hill-Sachs lesions
physical therapy
- control pain & swelling
- restore range of motion
- restore strength & endurance
- relearn proprioceptive & functional reflexes
bracing
- anterior dislocation:
  - limits abduction & external rotation
- posterior dislocation:
  - no effective bracing

↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 817-18