SHOULDER

DISLOCATION

Name- Asmita Tiwari

BPT III Year
Integral University
CONTENTS
 Introduction
 Classification
 Mechanism
 Clinical Features
 Special Tests
 Investigation
 Treatment
INTRODUCTION

 Dislocation of a shoulder is a common orthopedic injury.

 Dislocation is defined as a total loss of contact between the two

ends of bones .
Shoulder disloction - Head of humerus is not stable in glenoid cavity
and comes out from glenohumeral joint

 Shoulder is the commenest joint in the human body to dislocate.

 INCIDENCE : It is more common in adults and rare in children.

More common in males than females
CLASSIFICATION
Dislocation of shoulder is of following types:
1. Anterior dislocation- In this injury, the head of humerus
comes out of the glenoid cavity and lies anteriorly. It is
further classified into 3 sub-types depending on the position
of the dislocated head.

 Preglenoid- The head lies in front of the glenoid.

 Subcoracoid- The head lies below the coracoid process. Most
common type of dislocation.
 Subclavicular- The head lies below the clavicle.
2. Posterior Dislocation- In this injury, the head comes to lie
posteriorly, behind the glenoid.
3. Luxatio erecta (inferior dislocation)- This is a rare type, where
the head comes to lie in the subglenoid position.
MECHANISM
Mechanism can be direct and indirect.

 Anterior Dislocation- 95%

• Fall on out-stretched hand i.e FOOSH injury is the common
mechanism of injury.
• Fall on Abduction and external rotation of shoulder.
 Posterior Dislocation- 2 to 5%
• It may result from a direct blow on the front of the shoulder.
• Fall on adduction and internal rotation of shoulder
• Also associated with seizures and electric shock.
 Inferior Dislocation- <1%
• Hyperabduction injury
• High rate of nerves and vascular injury
CLINICAL FEATURES

Anterior Dislocation
• Arm in abduction and externally rotated.
• Humeral head palpable anteriorly.
• All movements are limited and painful.
• Loss of normal contour.
Posterior Dislocation
• Arm is adducted and internally rotated
• May notice posterior prominence head of humerus
• Tear of subscapularis muscle
Also some common features –
Pain(severe),swelling(diffuse),ecchymosis,loss of
function,flatness of muscle,assymetry of shoulder,slight
temperture raised ,tenderness and no movement (painful).
SPECIAL TESTS

1. Duga’s test - Patient seated .Instruct him to touch the opposite

shoulder and bring the elbow to the chest wall.
Inability to the touch the shoulder because of pain indicates
anterior dislocation of humeral head.

2. Hamilton ruler test - A ruler is placed on lateral aspect of arm

touches the acromion.(it fail to touch on normal side)
3. Callaway’s test – Increased anteroposterior diameter
of axilla

4. Bryant’s test – Anteriorly axillary fold is lowered

5. External rotation restriced

INVESTIGATION

 No other investigation is required except x-ray and clinical

examinations
 A-P view, Y view (Lateral view)
Anterior Dislocation Posterior Dislocation

Anterior Dislocation Posterior Dislocation

Inferior Dislocation
TREATMENT

Treatment of dislocation is reduction under sedation or general

anesthesia followed by immobilisation of the shoulder in a chest
arm bandage for 3 weeks. After the bandage is removed,
shoulder exercises are begun.

Reduction Techniques-
 Kocher’s Method- Most common used method
• Uses traction – counter traction method with following sequence
(TEAM) T – Traction ( longitudinal) E- External Rotation
A- Adduction M- Medial Rotation
 Hippocratic Method- The examiner pushes his leg into the
axilla(counter traction) of patient and pulls arm towards himself
(traction).
 Stimpson’s Method- Used in patient with old unreduced
anterior dislocation of shoulder between 3 to 6 weeks.
• Patient is asked to lie prone on the couch and weight is applied
over his forearm, which acts like, traction. Edge of bed is like
counter traction.
COMPLICATION

Complication can be divided into early and late.

 Early complication- Injury to axillary nerve resulting paralysis
of deltoid.
• Rotator cuff injury
• Tendon, ligament injury

 Late complication- The shoulder is the commonest joint to

undergo recurrent dislocation.
• Shoulder Instability
• Shoulder Stiffness