lec16.Commonshoulderdisorders.ppt.pptVIP

Clinical picture Loss of the contour of the shoulder may appear as a step Anterior bulge of head of humerus may be visible or palpable A gap can be palpated above the dislocated head of the humerus X-ray anterior shoulder dislocation Associated injuries of anterior Shoulder Dislocation Injury to the neuro vascular bundle in axilla Injury of the Axillary Nerve ( Usually stretching leading to temporary neuropraxia ) Associated fracture Axillary Nerve Injury It is a branch from posterior cord of Brachial plexus It hooks close round neck of humerus from posterior to anterior It pierces the deep surface of deltoid and supply it and the part of skin over it Axillary nerve injury Management of Anterior Shoulder Dislocation Is an Emergency It should be reduced in less than 24 hours or there may be Avascular Necrosis of head of humerus Following reduction the shoulder should be immobilized strapped to the trunk for 3-4 weeks and rested in a collar and cuff Methods of Reduction of anterior shoulder Dislocation Hippocrates Method ( A form of anesthesia or pain abolishing is required ) Stimpson’s technique ( some sedation and analgesia are used but No anesthesia is required ) Kocher’s technique is the method used in hospitals under general anesthesia and muscle relaxation Hippocrates Method Stimpson’s technique Kocher’s Technique Complications of anterior Shoulder Dislocation : Early Neurovascular injury ( rare ) Axillary nerve injury Associated Fracture of neck of humerus or greater or lesser tuberosities Complications of anterior shoulder Dislocation : Late Avascular necrosis of the head of the Humerus (high risk with delayed reduction) Recurrent shoulder dislocations (the commonest complication) , treated by Bankart repair (either arthroscopic or open) Bankart lesion Bankart lesion Arthroscopic Bankart repair Common shoulder disorders Basic shoulder anatomy Impingement syndrome Rotator cuff pathology Adhesive capsulitis Glenohumeral osteoarthritis Recurrent s