shoulder dislocation
TRANSCRIPT
SHOULDER DISLOCATION
MECHANISM OF INJURY
Anterior shoulder dislocation
Is caused by fall on an outstretched hand with shoulder abducted and externally rotated
It is a consequence of an electric shock or an epiletiform convulsion.
Classification
1) Anterior dislocation: 3 subtypesPreglenoid: the head lies infront of
the glenoid.Subcoracoid: head lies below the
coracoid process.Subclavicular: head lies below the
clavice.
Subcoracoid dislocation
2) Posterior dislocation
The head of the humerus comes to lie posteriorly, behind the glenoid.
3)Luxatio erecta
This is a rare type of condition where head comes to lie in the subglenoid postion
PATHOLOGY
BANKART’S LESION: stripping of the glenoid labrum along with the periosteum from the anterior surface of the glenoid and scapular neck.
Hill sach’s lesion: depression on the humeral head in its postero-lateral quadrant
DIAGNOSIS
Presenting complaints
Patient enters casualty with his shoulder abducted and the elbow supported with opposite hand.
There is a history of a fall on out-stretched hand followed by pain and inability to move the shoulder.
Examination
DUGAS TEST HAMILTON RULER TEST CALLWAY TEST ANTERIOR APPREHENSION TEST
TECHNIQUES OF REDUCTION OF SHOULDER DISLOCATION
KOCHER’S MANOEUVRE
HIPPOCRATES MANOEUVRE
KOCHER’S MANOEUVRE
HIPPOCRATES MANOEUVRE
COMPLICATIONS
EARLY COMPLICATION
Injury to axillary nerve resulting in paralysis of deltoid muscle with anaesthesia over the lateral aspect of shoulder.
LATE COMPLICATIONS
Recurrent dislocation due to various causes
TREATMENT
1. PUTTI – PLATT OPERATION
2.BANKART’S OPERATION
3. BRISTOW’S OPERATION
4. ARTHROSCOPIC BANKART REPAIR
Arthroscopic bankart repair
Non operative rehabilitation for anterior shoulder instability (by wilk) Phase 1: acute motion phase Goals : Reestablish non painful ROM :- Range of motion exercises Retard muscular atrophy :- Strengthening exercises Decrease pain and inflammation :- Therapeutic modalities NSAIDs Joint mobilization
Phase 2 : intermediate phase
Goals:Regain and improve muscle strengthNormalize arthrokinematics Improve neuromuscular control of
shoulder complex
Phase 3 : advanced strengthening phase
Goals: Improve strength, power and
endurance Improve neuromuscular controlPrepare patient for activity
Phase 4 : return to activityGoals:Maintain optimal level of strength
power and endurance.Progressively increase activity level
to prepare patient for full functional return to activity.