Factors that influence dislocation of the shoulder
joint • shallow bowl of glenoid joints • large range of motion • underlying conditions such as loose ligamentous or glenoid dysplasia • the joint is easily attacked during stressful activity in the upper limbs Classification Dislocation of the shoulder joint is classified into 4, namely: • 1. Anterior dislocation • 2. Posterior dislocation • 3. Inferior dislocation or erectile luxation • 4. Dislocation accompanied by fracture Anterior Dislocation Trauma Mechanism • Usually the patient falls with his hands out stretched or traumatized on the scapula itself and limbs in a lateral rotation position. • The humeral head is pushed forward and causes joint avulsion and cartilage avulsion along with the anterior glenoid labrum periosteum. • The humeral head is below the glenoid, subcorcoid and subclavicular. Diagnosis History: There is a clear history of trauma Physical examination : • Look: Slight abduction and external rotation and the arms are supported by healthy arms. From the front the acromion looks more prominent and the subacromial arch in the lower lateral part disappears and the shoulder looks like forming an angle to the elbow. • Feel: The anterior part is more prominent. Pinprick test interference can occur in the 'badge area' due to N. Axillary injury. • Move: Limited ROM and severe pain Rontgen • AP : overlapping between the humeral head and the glenoid fossa will appear, the humeral head is usually located below and medial to the joint bowl. • Lateral : showing humeral head coming out of the joint bowl. Therapy 1. With general anesthesia - Elbow joints are in 90o • The Hippocrates Method flexion position and traction The patient is laid on the is performed according to the floor, the limbs are pulled up humeral line and the humeral head is pressed with the feet to - Rotate laterally return to its place. - The arm is added and the • Kocher method elbow joint is brought close The patient lies on the bed to the body towards the and the surgeon stands next midline to the sufferer. Repositioning steps according to Kocher: - The arm is rotated medially so that the hand falls on the chest area 2. Without general Complications Early: - N.Aksilaris damage - Damage to blood vessels - Fracture-dislocation Later: • Stiff joints • Irreducible dislocation • Recurrent dislocation Posterior Dislocation Trauma Mechanism • Posterior dislocations are less common, accounting for less than 2% of all dislocations around the shoulder • Usually caused by direct trauma to the shoulder joint in a state of internal rotation. Diagnosis Physical examination : • Look: The arm stays in the medial rotation and is locked in that position. The front of the shoulder looks flat with a prominent choroidoid, but swelling can hide this deformity; but when viewed from above, posterior shift is usually seen. • Feel: Found a tenderness and a lump in the back of the joint. • Move: ROM of shoulder joint Rontgen • Anteroposterior (AP): humeral head because it rotates medially, looks abnormal (like a light bulb) and is quite far from the glenoid fossa (empty glenoid sign) • Lateral: this film will show subluxation or posterior dislocation and sometimes show indentations in the anterior aspect of the humeral head. Therapy • Acute dislocation is reduced (usually under general anesthesia) by pulling the arm while the shoulder is in the abduction position; allow a few minutes to release the humeral head and then slowly rotate the arm laterally while the humeral head is pushed forward. Complications • Irreducible dislocation • Recurrent dislocation