Shoulder dislocation

Question 1

What are the types of shoulder dislocation?

Answer 1

• Glenohumeral
• Acromioclavicular (12%)
• Sternoclavicular (uncommon)

Question 2

What are the types of glenohumeral dislocations?

Answer 2

• Anterior (95%)
• Posterior (4%)
• Inferior (1%)
• Superior (rare, protected by coracoacromial arch)

Question 3

What X-rays are required n suspected shoulder dislocation?

Answer 3

Shoulder X-ray from AP and transcapular Y view

Question 4

What are the risks and complications of shoulder dislocation?

Answer 4

• Axillary nerve injury
• Brachial plexus and radial nerve injury (rare)
• Axillary artery injury
• Rotator cuff tear (common in elderly)
• Hill-Sachs and Bankart Lesions

Question 5

What is the general management of shoulder dislocation?

Answer 5

• Prompt reduction in ED (patients may require analgesia to relax rotator cuff muscles; check neuromuscular status pre and post)
• Post reduction immobilisation
• Bankart lesions may require surgical asepsis

Question 6

Clinical signs of anterior shoulder dislocation?

Answer 6

• Outer end of clavicle abnormally tender and prominent
• Often swollen
• Shoulder pain
• Limited ROM
• Loss of shoulder contour and squaring of deltoid contour
• Shoulder externally rotated and abducted
• Palpable subacromial depression and may be able to feel humeral head below coracoid / in axilla

Question 7

What needs to be checked in shoulder dislocation, why, and what are the signs?

Answer 7

• Axillary nerve
• Runs round surgical neck of humerus so is prone to damage in dislocation and reduction
• Signs: deltoid paralysis, loss of regimental badge sensation

Question 8

What are Hills-Sachs lesions?

Answer 8

• Impaction fracture of humeral head against anterior glenoid
• Occurs in 35% of anterior dislocations and is a sign of recurrent dislocation

Question 9

What is a bankart lesion?

Answer 9

• Detachment of anterior inferior labrum +/- avulsion fracture
• Occurs in most significant dislocations and predisposes to future dislocation

Question 10

Clinical signs of posterior shoulder dislocation?

Answer 10

• Caused by lightning, electrical and seizure injuries
• Arm adducted and internally rotated
• Anterior shoulder squared with prominent coracoid
• Patient resists external rotation and abduction

Question 11

X-ray signs of posterior shoulder dislocation?

Answer 11

• Lightbulb sign
• Rim sign
• Trough sign

Question 12

Main features of inferior shoulder dislocation?

Answer 12

• Occurs following force to completely raised arm
• Arm fully abducted in vertical position (often behind patient’s head)
• Humeral head palpable on chest wall
• Highest incidence of axillary neuromvascular damage

Question 13

Clinical features of AC dislocation or subluxation?

Answer 13

• Fall onto shoulder or FOOSH during rugby
• Outer end of clavicle prominent, tender and swollen
• Reduced ROM
• Loss of shoulder contour

Question 14

Difference between AC subluxation and dislocation?

Answer 14

AC dislocation involves tearing of coracoclavicular ligament, subluxation does not