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SHOULDER
DISLOCATION
Anterior dislocations result from injuries that place the arm
in abduction, external rotation and extension. Posterior dislocations
are less common; the arm position is not important as they
follow seizures or electric shocks.
Evaluation
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The
contour of the shoulder is changed from the usual
curved appearance to one that is much more angular,
with a hollow area in place of the humeral head
(Figures 18.5 and 18.6) |
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Any
shoulder movement is painful; X-rays help to determine
if there is a fracture |
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Perform
a careful neurological examination to evaluate
for peripheral nerve or brachial plexus injury. |
Treatment
| 1 |
Reduce
acute dislocations with the patient supine. |
| 2 |
If
you have an assistant, he/she should place
a sheet or other material under the axilla
for counter traction. Pull slowly and steadily
on the flexed elbow (Figure
18.7). When the
patient relaxes the shoulder muscles, you will
feel the humeral head move into the joint socket.
If you are alone, place your foot in the axilla for counter traction and gently
pull on the arm (Figure 18.8). |
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| 3 |
After
reduction, place the arm in a sling and swath
to prevent abduction and external rotation
(Figure 18.9). |
| 4 |
Begin
strengthening exercises at 6 weeks, with an emphasis
on internal rotation strength. |
| 5 |
Recurrent
dislocations are treated similarly. After multiple
dislocations, consider surgical shoulder stabilization
to prevent further occurrences. |
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Make
the diagnosis by physical examination
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Treat
with closed manipulation
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X-rays
help to evaluate the reduction and the presence of
fractures
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Recurrent
dislocations are common, especially in younger patients.
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