mechanism ?
fall on land , or try to left something ,( external rotation )patient will come handling his dislocated arm with his intact arm
send x ray (three view , anterior , lateral , axillary view)
ap view :
will show overlapping shadow of the humeral head and glenoid fossa , with head usually lying below and medial(anterior dislocation) to the socket
(the humeral head displaced medially and inferiorly)
lateral view :
humeral head out line with socket
MRI : used to detect if there is tearing in capsule especially in recurrent anterior shoulder dislocation
how to manage anterior dislocation (reduction)?
examine arm for nerve and vessel injury before reduction(neurovascular examination)
analgesia/sedation , some dislocation need general analgesia and some need intraarticular injection of local anaesthesia (lidocaine)
methods of reduction ?
stimson's , hippocratic , kocher's methods
then send x ray to confirm reduction
after reduction , arm sling for 3 week (in age less than 30 yrs who at risk for recurrence ) or 1 week (in those with age >30 yrs who at risk of stiffness )
what's complications of shoulder dislocation ?
early:
rotator cuff tear
nerve injury (axillary nerve )
vascular injury
fracture dislocation
later :
shoulder stiffness
unreduced dislocation
recurrent dislocation
how to deal with any orthopedic case :
1-atlas life support (ABCDE)
2-neuro-vascular examination
3-proper x ray
4-reduction(according to the type), hip dislocation flex the knee,hip and elevate the hip in the direction of dislocation , shoulder three technique stimpson , kocher , hippocrates
5-after reduction , x ray and neurovascular exam should done (post op complication such as entrapment of sciatic nerve in hip dislocation causing foot drop)