0071643192.pdf

ORTHOPEDICS

Shoulder Injuries

ANTERIORSHOULDERDISLOCATION

DIAGNOSIS

There are four distinct types of anterior shoulder dislocation:

■ Subcoracoid (most common anterior shoulder dislocation > 90%)

■ Subglenoid

■ Subclavicular

■ Intrathoracic

DIAGNOSIS

■ Clinical: Outer round contour of shoulder is flattened. Displaced humeral

head is palpated inferiorly. Arm is abducted and slightly externally

rotated.

■ Two-view X-ray of the shoulder, including AP view and axillary or Y view

(see Figure 4.10), shows dislocation.

TREATMENT

Reduction methods for anterior dislocations:

■ Stimson or hanging weight

■ Scapular manipulation

■ Traction-countertraction

■ External rotation (Hennepin technique)

■ Milch (forward elevation)

■ Kocher (external rotation, forward elevation, followed by internal rotation)

and Hippocratic (foot in the axilla for counter-traction) techniques are not

recommendedbecause of unacceptable high complication rates.

■ Recheck pulse, motor, sensation, and apply Velpeau dressing or shoulder

immobilizer.

■ Orthopedic follow-up

COMPLICATIONS

■ Axillary nerve injuries. Loss of sensation at “badge” area of shoulder.

■ Bankart lesions: A tear of the anteroinferior glenoid labrum (often diag-

nosed on MRI, but may have bony component). If present, high incidence

of instability and may require surgery.

■ Hill-Sachs deformity: A defect on the posterolateral aspect of the humeral

head (impaction fracture; see Figure 4.11).

POSTERIORSHOULDERDISLOCATION

Requires significant direct force to the anterior shoulder classically from a

seizureorhigh-speed injury

DIAGNOSIS

■ Clinical: Arm is usually adductedand slightly internally rotated. The

coracoid process is prominent anteriorly.

■ On AP X-ray the proximal humerus may look like a lightbulb or drum-

stick(due to internal rotation). The humeral head is displaced posteriorly

in the Y or axillary view.

FIGURE 4.10. On the

scapular Y-view shoulder

radiograph for an anterior

dislocation, the humeral

head will often appear

anterior to the glenoid

[as pictured in (A) and for

a posterior dislocation the

humeral head will usually

appear posterior (B)].

Posterior Anterior

Normal

A Scapula

B

The Kocher and Hippocratic

techniques for reducing

anterior shoulder dislocations

have unacceptably high

complication rates.

Bankart lesions—

TUBS

Traumatic

Unilateral

Bankart

Surgery