Dislocated shoulder

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The dislocate shoulder is when the humeral head comes out of the shoulder joint. Symptoms include shoulder pain and instability. Complications may include a Bankart lesion, Hill-Sachs lesion, rotator cuff tear, or axillary nerve injury.

Shoulder dislocations often occur as a result of falling to the arm extended or to the shoulder. Diagnosis is usually based on symptoms and confirmed by X-rays. They are classified as anterior, posterior, inferior, and superior with most of the anterior.

Treatment is by reducing the shoulder that can be achieved by a number of techniques including contraction-traction, external rotation, skapular manipulation, and Stimson technique. After X-ray reduction is recommended for verification. The arm may be placed in a sling for several weeks. Surgery can be recommended to those with recurrent dislocations.

About 1.7% of people experience shoulder dislocation at one point in time. In the United States, this is about 24 per 100,000 people per year. They make up about half of the major joint dislocations seen in the emergency department. Men are more affected than women.

Video Dislocated shoulder

Signs and symptoms

• Significant pain, sometimes felt along the arm over the shoulder.
• Sensation that the shoulder slips out of joints during kidnapping and external rotation.
• Shoulders and arms held in external rotation (anterior dislocation), or internal adduction and rotation (posterior dislocation). Resilience of all movements.
• Numbness on the arm.
• Shoulders that look evacuated. Some dislocations result in extraordinarily square-looking shoulders.
• No bones are touched by the shoulders.

Maps Dislocated shoulder

Diagnosis

Diagnosis of shoulder dislocation is often suspected based on patient history and physical examination. Radiography is made to confirm the diagnosis. The most obvious dislocations on radiography show a mismatch of the glenohumeral joint. Posterior dislocations may be difficult to detect on standard AP radiography, but more easily detected in other views. After reduction, radiography is usually repeated to confirm successful reduction and to detect bone damage. After repeated shoulder dislocations, MRI scans can be used to assess soft tissue damage. In the case of repeated dislocations, apprehension tests (and anterior instability) are useful methods for determining the tendency for future dislocations.

There are three main types of dislocations: anterior, posterior, and inferior. Anide (advanced)

In more than 95% of shoulder dislocations, the humerus moves anteriorly. In most of them, the humeral head comes to rest under the coracoid process, which is referred to as a sub-coracoid dislocation. Sub-glenoid, subklavicular, and, very rarely, intrathoracic or retroperitoneal dislocations can also occur.

An anterior dislocation is usually caused by a direct blow to, or falling into an outstretched arm. The patient usually holds his arm that is rotated externally and is slightly kidnapped.

Hill-Sachs lesion is the impaction of the humerus head left by the glenoid ream during dislocation. Hill-Sachs deformity occurs in 35% -40% anterior dislocations. They can be seen on the X-ray facing forward when the arm is in internal rotation. The Bankart lesions are a disorder of the glenoid labrum with or without avulsion bone fragments.

Damage to the axillary arteries and axillary nerve (C5, C6) may occur. The axillary nerve injured in 37% makes it the most commonly injured structure with this type of injury. Other common, pertinent, nerve injuries include injury to the suprascular nerve (29%) and the radial nerve (22%). Axillary nerve damage results in deltoid muscle weakening or paralyzing and unilateral deltoid atrophy, the normal rounded contour of the missing shoulder. A patient with an injury to the axillary nerve will have difficulty in abducting the arm from about 15 Â ° away from the body. The supraspinatus muscle begins the abduction of a fully adducted position.

Posterior (backwards)

Posterior dislocation is rare, and usually due to muscle contraction due to electric shock or seizures. They may be caused by an imbalance of rotator cuff muscle strength. Patients typically present holding their arm are internally rotated and adduced, and show an anterior shoulder alignment with a prominent coracoid process.

Posterior dislocations may not be recognized, especially in elderly patients and unconscious trauma patients. The average interval of 1 year was recorded between injury and diagnosis in a series of 40 patients. Inferior_ (downward) "> Inferior (down)

Inferior dislocations are the least likely, occurring less than 1%. This condition is also called luxatio erecta because the arm appears to be held up or behind the head permanently. This is due to the excessive abduction of the arm that forces the humeral head against the acromion. Such injuries have high complication rates because many vascular, neurologic, tendon, and ligament injuries are likely to occur from this injury mechanism.

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Treatment

Rapid medical care should be sought for alleged dislocations. Usually, the shoulders are kept in the current position by using a splint or sling. A pillow between the arm and body can provide support and increase comfort. Strong analgesics are needed to relieve the pain of dislocation and distress associated with it.

Reductions

Reduction of the shoulder can be done with a number of techniques including traction-countertraction, external rotation, skapular manipulation, Stimson technique, Cunningham technique, or Milch technique. Pain can be managed during the procedure either by procedural sedation and analgesia or injecting lidocaine to the shoulder joint. Injecting lidocaine into the joints may be cheaper and faster. If the shoulder can not be moved in the emergency room, relocation in the operating room may be required. This situation occurs in about 7% of cases.

Post-reduction

There appears to be no difference in outcome when the arm is immobilized in internal versus external rotation after an anterior shoulder dislocation. A 2008 study of 300 people for nearly six years found that conventional shoulder immobilization in slings was not beneficial.

Surgery

In young adults involved in activities that are particularly demanding shoulder surgery may be considered. Arthroscopic surgical techniques can be used to repair glenoidal labrums, capsular ligaments, long anchor head cheeks or SLAP lesions or to tighten shoulder capsules.

Arthroscopy stabilization surgery has evolved from Bankart repair, a time-honored surgical treatment for repeated anterior instability of the shoulder. However, failure rates after Bankart improvement have been shown to increase significantly in patients with significant bone loss from glenoid (sockets). In such cases, better results have been reported with some form of glenoid bone enlargement such as Latarjet surgery.

Although posterior dislocation is much less frequent, subsequent instability is no less challenging and, again, some form of bone enlargement may be necessary to control instability.

There are still situations characterized by multi-directional instability, which has failed to respond satisfactorily to rehabilitation, falling below the previously recorded AMBRI classification. This is usually due to excessive and redundant capsules that no longer offer stability or support. Traditionally, this has responded well to the 'reef' procedure known as inferior capsular shift. Recently, procedures have been performed as an arthroscopic procedure, rather than open surgery, again with comparable results. Recently, procedures have been performed using radio frequency technology to shrink excessive shoulder capsules, although long-term results from these developments have not been proven.

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Prognosis

After anterior shoulder dislocation, the risk of dislocation in the future is about 20%. This risk is greater in males than in females.

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See also

• Shoulder problem

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References

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External links

Source of the article : Wikipedia