Nama : Ni Luh Ayu Aris Ulan Devi

NIM : 1802631051

SHOULDER DISLOCATION

Shoulder dislocation :

Definition of dislocation in any joint, is that two articular surfaces which are normally in
communication have become completely separated. Dislocation is the discharge (divorce) of the head of
the joint from the bowl. If only partially shifted is called subluxation and if all is called a
dislocation.Shoulder dislocation is a common injury. In around 90% of cases the shoulder dislocates
anteriorly. This is generally caused by a fall on the hand but is occasionally due to direct trauma.

Etiology : The shoulder joint is the most regularly dislocated joint in the body. The shoulder
can dislocate forward, backward, or downward, and completely or partially, though most occur
anteriorly. Fibrous tissue that joins the bones can be stretched or torn, complicating a dislocation. It
takes a strong force, such as a blow to the shoulder to pull the bones out of place. Extreme rotation can
pop the shoulder out of its socket. Contact sports injuries often cause a dislocated shoulder. Trauma
from motor vehicle accidents and falls are also a common source of dislocation.

Pathophysiology : Anterior dislocation is the most common, accounting for up to 97% of all shoulder
dislocations. Mechanism of injury is usually a blow to an abducted, externally rotated and extended
extremity. It may also occur with posterior humerus force or fall on an outstretched arm. On exam, the
arm is usually abducted and externally rotated, and the acromion appears prominent. There are
associated injuries in up 40% of anterior dislocations including nerve damage, or tears and fractures
associated with the labrum, glenoid fossa, and/or humeral head.

NAME Mr. US
AGE 30 th.
IDENTITY
ADDRESS Ubud
OCCUPATION Waitrer in restaurant
COMPLAINT MAIN COMPLAINT Instability and pain in the left shoulder
(KU)
The patient felt pain and unable to move the
left shoulder. The patient falls while working
to deliver food the previous day. Pain in high
CURRENT
itensity that felt by the patient and more
MEDICAL HISTORY
painful when trying to move the left
(RPS)
shoulder and pain release when patient is
rest. She doesn’t feel nausea, numbness and
tingling.
PAST MEDICAL shoulder dislocation due to a car driving an
HISTORY (RPD) accident three years ago and being taken to a
hospital for repositioning.
 FAMILY MEDICAL -
HISTORY
COMORBIDITIES -
MEDICAL HISTORY
He works as a waiter at a restaurant in the
SOCIAL MEDICAL Ubud area and he job duties in 8 hours a day
HISTORY and almost all the time doing work by going
around carrying food.
RESP. RATE 20x/minute
HEART RATE 85x/minute
GENERAL
BLOOD PRESSURE 120/80 mmHg
EXAMINATION
SPO2 99%
CONCIOUSNESS E4V5M6 (Compos Mentis)
- A bulge is visible anteriorly in thinner patients
caused by the humeral head
- The patient looks pain-free
STATIC - Arm held in an abducted and exnternal rotation
INSPECTION
position
- Loss of normal contour of the deltoid and
acromion prominent anteriorly and medially
DYNAMIC Range of motion is diminished and painful
- Tenderness (+)
- Humeral head palpable anteriorly
- All movements limited and painful
PALPATION
- Palpable fullness below the coracoid process
and towards the axilla
- Feels warm on the left shoulder
Regio Motion ROM Pain
Flexion Limited +
Extension Limited +
ACTIVE Shoulder External rotation Limited +
Dextra Internal rotation Limited +
Abduction Limited +
BASIC Adduction Limited +
Regio Motion Endfeel Pain
MOVMENT
Flexion Firm +
FUNCTION
PASSIVE Extension Firm +
Shoulder External rotation Firm +
Dextra Internal rotation Firm +
Abduction Firm +
Adduction Firm +
Patient unable to resist against minimal force
RESISTED
All movements limited and painful
1. Apprehension (crank) Test: +
SPESIFIC EXAMINATION 2. Relocation test : +
3. Sensation test
MEASUREMENT ROM S: 30° - 0 - 30°
F: 20°-0-20°
T: 10°-0-20°
MMT 1111 5555
 5555 5555
Pain (VAS) Tenderness : 4/10
Motion pain : 8/10
Rest pain : 0/10

MEDICAL DIAGNOSIS
S:
- structure of shoulder region
- joint of shoulder
- muscle of shoulder
IMPAIRMENT F:
- pain in joint
- mobility of joint functions
- stabilty of joint functions
PT DIAGNOSIS - muscle power function
lifting and carrying object
carrying, moving and handlling object
ACTIVITY
putting on clothes
LIMITATION
taking off clothes
fine and use
Work and employment
PARTICIPATION
community life
RESTRICTION
religion and spirituality
Limitation of functional ability with pain and
instability because of shoulder dislocation
EVALUATION PLANNING
Reduce pain
SHORT TERM Increase ROM
PLANNING Increase mucle power
Return to normal activity as soon as possible without
LONG TERM
pain
INTERVENTION
1. Repositioning/Reduction
- External rotation, with patient in the supine position. Note the gentle traction (small
arrow) and stabilization of the patient’s elbow in an adducted position while external
rotation is applied by holding the patient’s wrist (large arrow)
- While traction is maintained, the patient’s arm is slowly taken through a wide arc, from
the patient’s side, into a fully overhead position.
- Pull the arm straight overhead; then gently place it back into a neutral position over the
patient’s abdomen and examine the shoulder for a successful reduction.
2. Immbilization
Immobilization with the shoulder in a comfortable position of internal rotation, using a
shoulder sling and swathe, has been recommended for 3 weeks post reduction for most
patients. However, it is unclear whether 3 weeks is superior to 1 week with respect to the
rate of recurrent dislocation. Shoulder is immobilized using a sling in 10 degrees of
external rotation. During the immobilization period, the focus is on AROM of the elbow,
wrist and hand and reduction of pain. Isometrics can be incorporated for the rotator cuff
and biceps musculature.
3. AAROM to achieve full range of motion
The patient sits relaxed and assisted while moving the shoulder to flexion, extension,
 abduction, adduction, internal rotation and external rotation
4. Stretching
Stretching in particular posterior shoulder structures, pectoralis major and minor and any
other muscles with flexibility impairments
1. Avoid excessive movement of the shoulder
2. Avoid lying down on the soulder
EDUCATION
3. Avoid lifting weights on the shoulder
4. Avoid movement increases pain
1. Strengthening Exercise
Regular strengthening exercises once per two days without any joint
movements for the rotator cuff muscles group (Resisted exercise)
HOME 2. Stretching
PROGRAM Regular stretching of the pectoralis major and minor and any other
muscles with flexibility impairments is carried out after working for
where each stretch is held for 10-15 seconds, repeated every 2-3
times
- Pain is reduce :
Tenderness : 3/10
Motion pain : 2/10
EVALUATION
Rest pain : 0/10
- Range of Motion is increase
- Muscle power is increse