SHOULDER JOINT

DISLOCATION
RESNA JOSE

 Commonest joint to dislocate

Ball and socket type
Joint instability

 Common in adults
Anterior dislocation > posterior
dislocation
Achilles point

MECHANISM OF INJURY
Indirect fall on an outstretched
hand with shoulder abducted and
externally rotated
Direct direct force pushing the
humerus head
POSTERIOR DISLOCATION
direct blow on the front of shoulder
Electric shock & epileptiform
convulsions

VARIETIES
1. ANTERIOR DISLOCATION
.preglenoid
.subcoracoid
.Infraclavicular
2. POSTERIOR DISLOCATION
3. LUXATIO ERECTA subglenoid

CLINICAL FEATURES
Enters the casuality with shoulder
abducted and elbow supported with
the opposite hand
History of fall on outstretched hand
Followed by pain and inability to use
joint
Similar illness in the past

ON EXAMINATION
Shoilder abducted and externally
rotated
Flat shoulder
Fullness below clavicle due to
displaced head of humerus
Regiment badge sign injury to
axillary nerve

 Dugas test inability to touch opposite

shoulder
Hamilton ruler test ruler placed on
lateral side touches acromion & lateral
condyle of humerus simultaneously.
Callaways test circumference of axilla
is increased
Bryants test anterior axillary fold is at
a lower level

INVESTIGATIONS
X ray Anteroposterior view and axillary view
Bankart sign stripping of glenoid labrum
along with periosteum from the anterior
surface of the glenoid and scapular neck
Bony bankart lesion
Hill sachs lesion - depression in the
posterolateral quadrant of head of humerus
due to ompingement by the anterior edge of
glenoid
Rounding of the anterior glenoid rim.

ANTERIOR DISLOCATION

POSTERIOR DISLOCATION

Anterolateral defect
Vacant glenoid sign
Daylight sign
The trough line

POSTERIOR DISLOCATION

 Arthrography ehelps to evaluate

rotator cuff tears
CT scan helps to detect defect
inhead
MRI scan evaluates soft tissues and
bony injuries

TREATMENT
Stimsons gravity method
Kochers method
Hippocrates method

KOCHERS MANOEUVRE
Most commonly used method
Traction , external rotation ,
adduction , medial rotation (TEAM)

 Arm should be fastened to the chest

with a bodybandage for 3-4 weeks

COMPLICATIONS

Immediate injury to axillary nerve

Small area of anaesthesia
Pain on abducting shoulder
Good prognosis

LATE COMPLICATIONS
Recurrent dislocation( 80 %)
If age of first dislocation is 12 22,
recurrence rate 55%

CAUSES
failureto immobilise the joint for 34weeks after dislocatin
size and nature of damage at the
time of initial dislocation
Greater the trauma , lesser the
incidence
Younger the age lesser the chance of
recurrece

treatment
Triad of essential lesion
1. Hill sachs sign
2. Bankarts esion
3. Erosion of anterior rim of glenoid
cavity

CLINICAL TESTS
Sulcus sign for inferior dislocation
Orthopedic evaluation test for
glenohumeral instability of shoulder
Traction is applied inferiorly
A depresion occures just below the
acromion
Ledge sign

 The apprehension test

Relocation test

 Appehension test
Relocation test

MANAGEMENT
Surgery is the treatment of choice
Correct essential lesions and prevent
external rotation of arm.

 Putti platts operation

subcapsularis and capsule
overlapped and tightened
Bankarts operation detached
anterior structures are attached to
rim of glenoid cavity with suture
Staple capsulorrhaphy of Destot and
Roux bankarts lesion attached to
labrum with stapler

 Bristows operation transplantation

of corocoid process with its
attachments to the lower half of
anterior rim of glenoid

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