SHOULDER DISLOCATION

MECHANISM OF INJURY

Anterior shoulder dislocation

Is caused by fall on an outstretched hand with shoulder abducted and externally rotated

It is a consequence of an electric shock or an epiletiform convulsion.

Classification

1) Anterior dislocation: 3 subtypesPreglenoid: the head lies infront of

the glenoid.Subcoracoid: head lies below the

coracoid process.Subclavicular: head lies below the

clavice.

Subcoracoid dislocation

2) Posterior dislocation

The head of the humerus comes to lie posteriorly, behind the glenoid.

3)Luxatio erecta

This is a rare type of condition where head comes to lie in the subglenoid postion

PATHOLOGY

BANKART’S LESION: stripping of the glenoid labrum along with the periosteum from the anterior surface of the glenoid and scapular neck.

Hill sach’s lesion: depression on the humeral head in its postero-lateral quadrant

DIAGNOSIS

Presenting complaints

Patient enters casualty with his shoulder abducted and the elbow supported with opposite hand.

There is a history of a fall on out-stretched hand followed by pain and inability to move the shoulder.

Examination

DUGAS TEST HAMILTON RULER TEST CALLWAY TEST ANTERIOR APPREHENSION TEST

TECHNIQUES OF REDUCTION OF SHOULDER DISLOCATION

KOCHER’S MANOEUVRE

HIPPOCRATES MANOEUVRE

KOCHER’S MANOEUVRE

HIPPOCRATES MANOEUVRE

COMPLICATIONS

EARLY COMPLICATION

Injury to axillary nerve resulting in paralysis of deltoid muscle with anaesthesia over the lateral aspect of shoulder.

LATE COMPLICATIONS

Recurrent dislocation due to various causes

TREATMENT

1. PUTTI – PLATT OPERATION

2.BANKART’S OPERATION

3. BRISTOW’S OPERATION

4. ARTHROSCOPIC BANKART REPAIR

Arthroscopic bankart repair

Non operative rehabilitation for anterior shoulder instability (by wilk) Phase 1: acute motion phase Goals : Reestablish non painful ROM :- Range of motion exercises Retard muscular atrophy :- Strengthening exercises Decrease pain and inflammation :- Therapeutic modalities NSAIDs Joint mobilization

Phase 2 : intermediate phase

Goals:Regain and improve muscle strengthNormalize arthrokinematics Improve neuromuscular control of

shoulder complex

Phase 3 : advanced strengthening phase

Goals: Improve strength, power and

endurance Improve neuromuscular controlPrepare patient for activity

Phase 4 : return to activityGoals:Maintain optimal level of strength

power and endurance.Progressively increase activity level

to prepare patient for full functional return to activity.