Dislocated shoulder
From Wikipedia, the free encyclopedia
| Dislocated shoulder | |
| Classification and external resources | |
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|
|---|---|
| The left shoulder and acromioclavicular joints, and the proper ligaments of the scapula. | |
| ICD-10 | S43.0 |
| ICD-9 | 831 |
| DiseasesDB | 31231 |
| eMedicine | orthoped/440 radio/630 sports/152 |
| MeSH | D012783 |
A dislocated shoulder occurs when the humerus separates from the scapula at the glenohumeral joint. As the most maneuverable joint in the human body, the shoulder is the joint most vulnerable to dislocation. Approximately half of major joint dislocations seen in emergency departments are of the shoulder. Partial dislocation of the shoulder is referred to as subluxation.
Contents |
[edit] Types
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This section requires expansion. |
[edit] Anterior (forward)
Over 95% of shoulder dislocation cases are anterior. Most anterior dislocations are sub-coracoid. Sub-glenoid; subclavicular; and, very rarely, intrathoracic or retroperitoneal dislocations may occur.[1]
It can result in damage to the axillary artery.[2]
[edit] Posterior (backward)
Posterior dislocations are occasionally due to electrocution or seizure and may be caused by strength imbalance of the rotator cuff muscles. Posterior dislocations often go unnoticed, especially in an elderly patient.[3] An average interval of 1 year was discovered between injury and diagnosis of posterior dislocation in a series of 40 patients.[4]
[edit] Inferior (downward)
Inferior dislocation is the least likely form, occurring in less than 1% of all shoulder dislocation cases. This condition is also called luxatio erecta because the arm appears to be permanently held upward or behind the head.[5] It is caused by a hyper abduction of the arm that forces the humeral head against the acromion. Inferior dislocations have a high complication rate as many vascular, neurological, tendon, and ligament injuries are likely to occur from this kind of dislocation.
[edit] Signs
- Significant pain, which can sometimes be felt past the shoulder, along the arm.
- Inability to move the arm from its current position, particularly in positions with the arm reaching away from the body and with the top of the arm twisted toward the back.
- Numbness of the arm.
- Visibly displaced shoulder. Some dislocations result in the shoulder appearing unusually square.
- No bone in the side of the shoulder showing shouler has become dislocated
[edit] Treatment
[edit] Initial
Prompt professional medical treatment should be sought for any suspected dislocation injury. Usually, a dislocated shoulder is kept in its current position by use of a splint or sling (however, see below). A pillow between the arm and torso may provide support and increase comfort. Ice may help reduce pain.[6]
Emergency department care is focused on returning the shoulder to its normal position via processes known as reduction. Normally, closed reduction, in which several methods are used to manipulate the bone and joint from the outside, is used. A variety of techniques exist, but some are preferred due to fewer complications or easier execution.[7] In cases where closed reduction is not successful, surgical open reduction may be needed.[8] Following reduction, X-Ray imaging is often used to ensure that the reduction was successful and there are no fractures. The arm should be kept in a sling or immobilizer for several days, preferably until orthopedic consultation. Hippocrates' method is not used anymore. Hippocrates used to place the heel in the axilla and reduce shoulder dislocations. Kocher's method, the most popular method of reducing shoulder dislocation, should be done only under anesthesia as the patient may go in neurogenic shock because of the pain. Traction is applied on the arm and it is abducted. Then, it is externally rotated, and the arm is adducted following which it is internally rotated and maintained in the position with the help of a sling. A check xray should be taken to confirm whether the head of humerus has reduced back into the glenoid cavity
[edit] Post-reduction: Is a sling really necessary?
For thousands of years, treatment of dislocated shoulders has included immobilization of the patient's arm in a sling, with the arm placed in internal rotation. However, recent studies performed on both cadavers and humans have found that immobilizing the arm in such position doesn't do any good[9] and that much better results are obtained if the arm is immobilized in external rotation, 90 degrees from the body[10].
Other studies have found that the use of a sling doesn't do any good at all, and that the rate of recurrent dislocation of the patients who did not wear a sling was the same as the patients who did.[11]
[edit] Therapy
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This section requires expansion. |
In many cases, particularly for individuals not subject to high occupational risk of dislocation, physical therapy and/or occupational therapy can strengthen the shoulder and produce satisfactory shoulder stability. After pain and swelling have been controlled or stopped, the patient will enter a rehabilitation program that includes exercises to strengthen the rotator cuff.. Doing this will help restore the range of motion of the shoulder and strengthen the muscles to prevent future dislocations. These exercises may start at simple motions of the arm to the use of weights.
[edit] Surgery
Some cases require non-emergency surgery to repair damage to the tissues surrounding in the shoulder joint and restore shoulder stability. Arthroscopic surgery techniques may be used to repair the glenoidal labrum, capsular ligaments, biceps long head anchor or SLAP lesion and/or to tighten the shoulder capsule. [12].
The time-proven surgical treatment for recurrent anterior instability of the shoulder is a Bankart repair [13]. When the front of the shoulder socket has been broken or worn, a bone graft may be required to restore stability [14]. When the shoulder dislocates posteriorly (out the back), a surgery to reshape the socket may be necessary [15].
New procedure that should be investigated as an option as opposed to open surgery. http://orthoinfo.aaos.org/topic.cfm?topic=A00034
[edit] See also
[edit] References
- ^ Shoulder Dislocations at eMedicine
- ^ Kelley SP, Hinsche AF, Hossain JF (November 2004). "Axillary artery transection following anterior shoulder dislocation: classical presentation and current concepts". Injury 35 (11): 1128–32. doi:. PMID 15488503. http://linkinghub.elsevier.com/retrieve/pii/S0020138303003346.
- ^ Dislocations, Shoulder at eMedicine
- ^ Hawkins RJ, Neer CS, Pianta RM, Mendoza FX (January 1987). "Locked posterior dislocation of the shoulder". J Bone Joint Surg Am 69 (1): 9–18. PMID 3805075. http://www.medscape.com/medline/abstract/3805075?src=emed_ckb_ref_0.
- ^ Dislocations, Shoulder~clinical at eMedicine
- ^ Dislocated shoulder: Extensive injury needs prompt attention - MayoClinic.com
- ^ Dislocations, Shoulder~workup at eMedicine
- ^ Dislocated shoulder: Extensive injury needs prompt attention: Treatment - MayoClinic.com
- ^ Murrell GA (October 2003). "Treatment of shoulder dislocation: is a sling appropriate?". Med. J. Aust. 179 (7): 370–1. PMID 14503903. http://www.mja.com.au/public/issues/179_07_061003/mur10335_fm.html.
- ^ http://www.ori.org.au/bonejoint/shoulder/ssfd.htm
- ^ Chalidis B, Sachinis N, Dimitriou C, Papadopoulos P, Samoladas E, Pournaras J (June 2007). "Has the management of shoulder dislocation changed over time?". Int Orthop 31 (3): 385–9. doi:. PMID 16909255. PMC: 2267594. http://www.springerlink.com/content/e845216618wj6247/.
- ^ Considering surgery - Arthroscopic shoulder surgery for shoulder dislocation, subluxation, and instability: why, when and how it is done
- ^ "Bankart repair for unstable dislocating shoulders: Surgery to anatomically and securely repair the torn anterior glenoid labrum and capsule without arthroscopy can lessen pain and improve function for active individuals.". University of Washington: Orthopaedics and Sports Medicine. http://www.orthop.washington.edu/openbankart.
- ^ "Anterior glenoid reconstruction for unstable dislocating shoulders. Surgery to restore lost anterior glenoid bone and deep the socket with a bone graft can restore shoulder anatomy and lessen pain and improve function.". University of Washington: Orthopaedics and Sports Medicine. http://www.orthop.washington.edu/shoulderbonegraft.
- ^ "Posterior glenoid osteoplasty for unstable dislocating shoulders. Surgery to build up the back of the glenoid socket using an osteotomy and graft can restore shoulder anatomy and lessen pain and improve function.". University of Washington: Orthopaedics and Sports Medicine. http://www.orthop.washington.edu/glenoidosteoplasty.
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