SHOULDER DISLOCATION

-Maj Sunil
Plan
• Introduction
• Types of shoulder dislocation
• Recurrent shoulder dislocation
• Associated lesions
• Treatment
• Aeromedical concern
 Introduction
• Multiaxial ball and socket joint
• Extremely mobile joint - jeopardizes its stability.

• An unstable joint
– Shallow glenoid cavity
– Articulates with a small part of the humeral head
(30%).

• Constitutes 50% of all major joint dislocations.

Types of shoulder dislocation
 Types
Anterior dislocation
• Most common, 97% of all shoulder dislocations.

• MoI :
• Blow to an abducted, externally rotated and extended extremity.
• Posterior humerus force or fall on an outstretched arm.

• O/E : Abducted and externally rotated arm, prominent acromion

• Associated injuries – in upto 40% cases

• Includes-
• Nerve damage
• Tears and fractures
 Labrum
 Glenoid fossa
 Humeral head.
 Types
Anterior dislocation
• Most common, 97% of all shoulder dislocations.

• MoI :
• Blow to an abducted, externally rotated and extended extremity.
• Posterior humerus force or fall on an outstretched arm.

• O/E : Abducted and externally rotated arm, prominent acromion

• Associated injuries – in upto 40% cases

• Includes-
• Nerve damage
• Tears and fractures
 Labrum
 Glenoid fossa
 Humeral head.
 Types
Posterior dislocations
• 2% to 4% of shoulder dislocations.
• MoI :
• Hit to anterior shoulder
• Axial loading of the adducted, internally rotated arm
• Violent muscle contractions (seizures, electrocution).

• O/E: Adducted and internally rotated arm and

unable to rotate externally.

• Associated injuries-
• # Humerus ( surgical neck / tuberosity)
• Reverse Hill-Sachs lesions (also called McLaughlin lesion)
• Injuries of the labrum or rotator cuff.
 Types
Posterior dislocations
• 2% to 4% of shoulder dislocations.
• MoI :
• Hit to anterior shoulder
• Axial loading of the adducted, internally rotated arm
• Violent muscle contractions (seizures, electrocution).

• O/E: Adducted and internally rotated arm and

unable to rotate externally.

• Associated injuries-
• # Humerus ( surgical neck / tuberosity)
• Reverse Hill-Sachs lesions (also called McLaughlin lesion)
• Injuries of the labrum or rotator cuff.
 Types
Inferior dislocation (luxatio erecta)
• Most uncommon type (less than 1%).
• MoI –
• Hyperabduction or
• Axial loading on the abducted arm.

• O/E :
• Arm held above and behind the head
• Unable to adduct arm.

• Associated injuries-
• Axillary nerve and artery injury (highest incidence)
• Rotator cuff injury
• Tears in the internal capsule
 Types
Inferior dislocation (luxatio erecta)
• Most uncommon type (less than 1%).
• MoI –
• Hyperabduction or
• Axial loading on the abducted arm.

• O/E :
• Arm held above and behind the head
• Unable to adduct arm.

• Associated injuries-
• Axillary nerve and artery injury (highest incidence)
• Rotator cuff injury
• Tears in the internal capsule
 Recurrent Shoulder Dislocation

• Very common complication of anterior dislocation of shoulder

• Factors contributing for recurrence :

– Age at the time of initial dislocation
• 12 to 22 yrs : 55%
• 23 to 29 yrs : 37%
– Failure to immobilize the shoulder for 3 to 4 weeks after initial dislocation.
– Severity of trauma

Ebnezar, John & John, (2017). Textbook of Orthopedics 10.5005/jp/books/13033.

 Triad of Essential Lesion
• Hill-Sachs lesion:
– Posterolateral defect in the head of the humerus.
– Due to impact of posterolateral part of the head of humerus against sharp anterior margin of
glenoid rim.

• Bankart’s lesion:
– Defect in the anterior part of glenoid labrum and anterior capsule

• Erosion of anterior rim of glenoid cavity

• Reverse Hill-Sachs lesions (McLaughlin lesion):

• Impaction fracture of anteromedial aspect of humeral head
Hill-Sachs defect

Posterior surface of the shoulder showing a

subcoracoid dislocation of the humeral head,
with impaction of the anterior glenoid rim into
the posterior humeral head.
Hill-Sachs defect
 Bankart lesion

A Bankart lesion is a tear in the labrum (anteroinferior aspect) — the cartilage

rim around the edge of the shoulder socket.
 Management
• No role of conservative treatment in recurrent dislocation of shoulder.

• Surgery
– Treatment of choice
– Indicated if more than three episodes of RDS.
– More than 150 operations available

• All the surgeries aim at correction of the essential lesions.

• Arthroscopic Bankart repair - treatment of choice for anterior glenohumeral
instability

Chahal J, Marks PH, Macdonald PB, et al. Anatomic Bankart repair compared with nonoperative treatment and/or arthroscopic lavage for
first-time traumatic shoulder dislocation. Arthroscopy. 2012;28(4):565-575. doi:10.1016/j.arthro.2011.11.012
Sofu H, Gürsu S, Koçkara N, Oner A, Issın A, Camurcu Y. Recurrent anterior shoulder instability: Review of the literature and current concepts. World J Clin Cases
2014 Nov 16;2(11):676-82. doi: 10.12998/wjcc.v2.i11.676. PMID: 25405191; PMCID: PMC4233422.
Arthroscopic Bankart repair
Arthroscopic Bankart repair
 Aeromedical concern
• Cockpit actions requiring adequate shoulder strength :
– Brake-Chute handle :
• Pull Handle,
• Placed above shoulder level,
• Requires adequate strength (3-5Kg force required)
– Canopy jettison handle:
• At shoulder level,
• Push movement
– Emergency undercarriage lever: pull lever ( only incase of emergency)
– Normal Canopy operation:
• Lever on rt hand,
• Push the canopy with left hand , arm above shoulder level (hinge on the back)
• Around 3kg force needed

• Pilots notes on jaguar .

• Recurrence rate
– Without surgical correction : 20% – 75%
– Post Arthroscopic Bankart repair : 7%
– Post Conventional / open repair : 38%
• Incidence of Glenohumeral Osteoarthrosis post RDS : 12% - 62%

• Polyzois I, Dattani R, Gupta R, Levy O, Narvani AA. Traumatic First Time Shoulder Dislocation: Surgery vs Non-Operative Treatment. Arch
Bone Jt Surg. 2016 Apr;4(2):104-8. PMID: 27200385; PMCID: PMC4852033.
• Chahal J, Marks PH, Macdonald PB, et al. Anatomic Bankart repair compared with nonoperative treatment and/or arthroscopic lavage
for first-time traumatic shoulder dislocation. Arthroscopy. 2012;28(4):565-575. doi:10.1016/j.arthro.2011.11.012
• Ebnezar, John & John, (2017). Textbook of Orthopedics 10.5005/jp/books/13033.
• Coifman I, Brunner UH, Scheibel M. Dislocation Arthropathy of the Shoulder. J Clin Med. 2022 Apr 4;11(7):2019. doi:
10.3390/jcm11072019. PMID: 35407627; PMCID: PMC8999818.
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