dislocations of the shoulder
DESCRIPTION
shoulder dislocation for undergraduates/PT/OTTRANSCRIPT
Shoulder DislocationShoulder Dislocation
Mr. Mubarak M AbdelkerimMr. Mubarak M AbdelkerimConsultant Orthopaedic SurgeonConsultant Orthopaedic Surgeon
MBBS MS MCh Orth FRCSI FRCSEd FRSMMBBS MS MCh Orth FRCSI FRCSEd FRSM
VISIONVISION
• IF YOU CAN IMAGINE IT,YOU CAN ACHIEVE IT.
• IF YOU CAN DREAM IT ,YOU CAN BECOME IT.
Shoulder instabilityShoulder instability
• The glenohumeral joint has little mechanical stability because of
• 1-Its shallow socket and large ball • 2-Extra ordinary range of movement . • This minimal stability achieved by • 1-capsul- labral complex .• 2-glenohumeral ligament • 3- negative intra articular pressure & suction cup
effect of glenoid labrum • 4-dynamic stabilizer (Rotator cuff muscle.
ClassificationClassification
• 1-DISLOCATION / SUBLAXATION
• 2-ACUTE /CHRONIC
• 3-VOLUNTRAY /INVOLUNTORY
• 4-TRAUMATIC/ATRAUMATIC;
Cont.Cont.
1-TUBS(traumatic unilateral Bankart lesion and surgery) torn
losses): generally describe traumatic instability any injury can be
identified –repaired restoring stability .
2- AMBRI (Atraumtic Multidirectional Bilateral Rehabilitation & Inferior capsular shift )(born losses).
Describe the condition in which the joint unstable with out any
Patho- anatomyPatho- anatomy
When the glenohumeral joint dislocates the following injuries can be inflicted:-
1-Bankart lesion: Avulsion of inferior glenohumeral ligaments –the labrum &
the capsular attachment on Antero –inferior aspect of gelnoid rim and is found in most of traumatic ant dislocation
2-Bony Bankart: lesion: soft tissue lesion plus fracture glenoid rim
3-Hill-Sachs lesion Is impaction fracture of humeral head on the glenoid rim
Mechanism of injuryMechanism of injury
1. ANTERIOR DISLOCATION;• Usually following fall on outstretched hand the
humerous driven forward stretching capsule or avulsion the gleniod labrum a typical way is arm abducted and in ext rotation
• 2.POSTEIOR DISLOCATION: . Sever force needed to cause marked adduction &
internal rotation commonly caused during fits & with electric shock. ( Ethanol)
DiagnosisDiagnosis • CLINICAL EXAMINATION :• *careful exam should provide an accurate impression
of instability –the asymptomatic shoulder must be examined to establish normal value.
• INSPECTION :• Look for muscle wasting-contracture change in
colour&posture• MOVEMENT:• Active &passive movement should be assessed the
standard plane are flexion –abduction &extension –external rotation with elbow 90 internal rotation when PT reach up his back.
ContinuedContinued
CLINICAL TEST :1-DRAW TEST 2-ANTERIOR APPREHENSION TEST sensitive for ant instability 3-JOBES RELOCATION TEST4-Sulcus Test • FURTHER EXAM – under aid of anaesthesia is
always carried out before surgical stabilizing including draw test assessment of passive &active movement
InvestgationInvestgation
1-X-RAY ANTERIO POSTERIOR VIEW AXILLARY VIEW IS STANDARD *X-ray also need to exclude other injuries2-CT• useful if significant bone damage is suspected 3-M R I is non invasive &can identify most tissue damage 4-ARTHROSCOPY give accurate impression of damage to the joint
Treatment Treatment
1-Careful examination the to axillary and musclo- cutaneous nerve
2-Sedation unless there is fracture or nerve injury general anaesthsia is mandatory
3-Reduction
4-Surgical Treatment
ContinuedContinued
AFTER TREATMENT :• Arm should be in a broad arm sling for 2-6 weeks
• Physiotherapy at sixth weeks
• Full activity at10th week
• Contact sport at fourth month