Extremity Joint

Dislocation
SHOULDER JOINT DISLOCATION

Factors that influence dislocation of the shoulder

joint
• shallow bowl of glenoid joints
• large range of motion
• underlying conditions such as loose ligamentous or
glenoid dysplasia
• the joint is easily attacked during stressful activity
in the upper limbs
Classification
Dislocation of the shoulder joint is classified into 4,
namely:
• 1. Anterior dislocation
• 2. Posterior dislocation
• 3. Inferior dislocation or erectile luxation
• 4. Dislocation accompanied by fracture
Anterior Dislocation
Trauma Mechanism
• Usually the patient falls with his hands out
stretched or traumatized on the scapula itself and
limbs in a lateral rotation position.
• The humeral head is pushed forward and causes
joint avulsion and cartilage avulsion along with the
anterior glenoid labrum periosteum.
• The humeral head is below the glenoid, subcorcoid
and subclavicular.
Diagnosis
History: There is a clear history of trauma
Physical examination :
• Look: Slight abduction and external rotation and the
arms are supported by healthy arms. From the front
the acromion looks more prominent and the
subacromial arch in the lower lateral part disappears
and the shoulder looks like forming an angle to the
elbow.
• Feel: The anterior part is more prominent. Pinprick test
interference can occur in the 'badge area' due to N.
Axillary injury.
• Move: Limited ROM and severe pain
Rontgen
• AP : overlapping between the humeral head and
the glenoid fossa will appear, the humeral head is
usually located below and medial to the joint bowl.
• Lateral : showing humeral head coming out of the
joint bowl.
Therapy
1. With general anesthesia
• The Hippocrates Method
The patient is laid on the
floor, the limbs are pulled up
and the humeral head is
pressed with the feet to
return to its place.
• Kocher method
The patient lies on the bed
and the surgeon stands next
to the sufferer. Repositioning
steps according to Kocher:
- Elbow joints are in 90o
flexion position and traction
is performed according to the
humeral line
- Rotate laterally
- The arm is added and the
elbow joint is brought close
to the body towards the
midline
- The arm is rotated medially
so that the hand falls on the
chest area
2. Without general
Complications
Early:
- N.Aksilaris damage
- Damage to blood vessels
- Fracture-dislocation
Later:
• Stiff joints
• Irreducible dislocation
• Recurrent dislocation
Posterior Dislocation
Trauma Mechanism
• Posterior dislocations are less common, accounting
for less than 2% of all dislocations around the
shoulder
• Usually caused by direct trauma to the shoulder
joint in a state of internal rotation.
Diagnosis
Physical examination :
• Look: The arm stays in the medial rotation and is
locked in that position. The front of the shoulder
looks flat with a prominent choroidoid, but swelling
can hide this deformity; but when viewed from
above, posterior shift is usually seen.
• Feel: Found a tenderness and a lump in the back of
the joint.
• Move: ROM of shoulder joint
Rontgen
• Anteroposterior (AP): humeral head because it
rotates medially, looks abnormal (like a light bulb)
and is quite far from the glenoid fossa (empty
glenoid sign)
• Lateral: this film will show subluxation or posterior
dislocation and sometimes show indentations in
the anterior aspect of the humeral head.
Therapy
• Acute dislocation is reduced (usually under general
anesthesia) by pulling the arm while the shoulder is
in the abduction position; allow a few minutes to
release the humeral head and then slowly rotate
the arm laterally while the humeral head is pushed
forward.
Complications
• Irreducible dislocation
• Recurrent dislocation