DISLOCATION OF

SHOULDER
-Rakshita Jain
Batch 2017
17063
Anatomy

■ Synovial joint of ball and socket variety

Articular surface

■ The joint is formed by articulation of the glenoid cavity of scapula and the head of the
humerus. Therefore, itk also known as the glenohmeral articulation.
■ Structurally it is a weak joint because the solenoid cavity is too small and shallow to
hold the head of the humerus in place.
■ However, this arrangement permits greater mobility.
Ligaments

■ The capsular ligaittent: It is very loose and permits free movements. It is least supported
inferiorly where dislocations are common. Such a dislocation may damage the closely
related amary nerve.
■ Medially, the capsule is attached to the scapula beyond the supraglenoid Mbercle and
the margins of the labrum.
■ Laterall it is attached to tlle anatomical neck oi the humerus with the followilrg
exceptions: Inferiorly, the attachment extends down to the surgical neck.
■ Superiorly, it is deficierrt for passage of tire tendon of the long head of the biceps
brachii.
Anteriorly, the capsule is reinforced by supple- mental bands caiied the superior, middle and
inferior glenohumeral ligaments. The area between the superior and middle glenohumeral
ligament is a point of weakness in the capsule( foramen of Weitbrecht) which is a common
site of anterior dislocation humeral head.
■ The capsule is lined with synovial mermbrane. An extension of this membrane forms a
tubular sheath for the tendon of the long head of the biceps brachii.
■ Tlze coracokumeral ligament: It extends from the root of the coracoid process to the
neck of the humerus , opposite the greater tuberose. It gives strength superiorly.
■ Transverse numeral ligament It bridges the upper part of the bicipital groove of the
humerous (between the greater and lesser tubercles). The tendon of the long head of the
biceps brachii passes deep to the ligament.
■ Glenoid labrum it is. Fibrocartilaginous rim which covers the margins of the glenoid
cavi{y, thus increasing the depth of the cavity-
Dislocation

■ Commonest
■ More common in adults
■ Rare in children
■ Anterior is more common than posterior
Shoulder instability

■ This is a broad term used for shoulder problems, where head of the humerus is not
stable in the glenoid. It has a wide spectrum -from minor instability or a 'loose shoulder'
to a frank dislocation. In the former, the patient may present with just pain in the
shoulder, more on using the shoulder. Pain occurs due to stretching of the capsule, as the
head 'moves out' in some direction without actually dislocating. A patient with frank
instability may present with an 'abnormal' movement of the head of the humerus. This
could be partial movement (subluxation) which gets spontaneously reduced, or a
dislocation. The instability may be in one direction (unidirectional) or more
(bidirectional). It may be in multiple directions-anterior, inferior, posterior, where it is
called multi-directional instability (MDI).
Mechanism

■ A fall on an out-stretched hand with the shoulder abducted and externally rotated, is the
common mechanism of injury. Occasionally, it results from a direct force pushing the
humerns head out of the glenoid cavity. A posterior dislocation may result from a direct
blow on the front of the shoulder, driving the head backwards. More often, however,
posterior dislocation is the consequence of electric shock or an epileptic form of
convulsion.
Pathoanatomy

Dislocation may be
■ Anterior
■ Posterior
■ Inferior
Anterior dislocation

■ In this injury, the head of the humerus comes out of the glenoid cavity and lies
anteriorly. It may be further classified into three subtypes depending on the p° sition of
the dislocated head
■ Preglenoid: The head lies in front of the glenoid.
■ · Subcoracoid: The head lies below the coracoid process. Most common type of
dislocation. ·
■ Subclavicular: The head lies below the clavicle.
Posterior dislocation

■ The head of humerus comes to lie posteriorly, behind the glenoid

Inferior dislocation ( Luxatio erecta)

■ Rare
■ Head comes to lie in the subglenoid position
Pathological changes

In anterior dislocation
■ Bankart s lesion
■ Hill-Sachs lesion
■ Rounding off
■ Associated injuries
■ Bankart's lesion: Dislocation causes stripping of the glenoidal labrum along with the
periosteum from the antero-inferior surface of the glenoid and scapular neck. The head
thus comes to lie in front of the scapular neck, in the pouch thereby created. In severe
injuries, it may be avulsion of a piece of bone from antero-inferior glenoid rim, called
bony Bnnknrt lesion.
■ Hill-Sachs lesion This is a depression on the hmeral head in its postero-lateral quadrant,
caused by impingement by the anterior edge of the glenoid on the head as it dislocates.
■ Rounding off the anterior glenoid rim occurs In chronic cases as the head dislocates
repeatedly over it.
Associated injuries

■ Fracture of greater tuberosity

■ Rotator cuff tear
■ Chondral damage