GLENOHUMERALDISLOCATION-EDExam.docVIP

GLENOHUMERAL DISLOCATION Anterior = most common Posterior 2% Inferior (luxatio erecta) = rare Superior = very rare Always do neurovasc exam before after. ANTERIOR DISLOCATION 4 types: Subcoracoid – ant to glenoid, inf to coracoid Subglenoid – inf and ant to glenoid fossa Subclavicular – displaced medially below clavicle Intrathoracic – between ribs ABDUCTED SLIGHT EXT ROTATION Resist abduction INTERNAL rotation Remember to test axillary nerve – shoulder tip sensation Commonest associated injury = BANKART (90%) COMMONEST COMPLICATION = RECURRENT DISLOCATION Age 20yo = 90% recurrence (usually due to Bankart) Age 40yo = 10-15% recurrence ASSOCIATED INJURIES 1) BONE HUMERUS i) Hill-Sachs: Posterolateral humeral head indentation fracture Soft base of humeral head impacts against relatively hard anterior glenoid - seen in 35-60% of anterior dislocations - up to 80 % of recurrent dislocations May destabilizes glenohumeral joint may predispose to further dislocation Best seen with “Stryker-notch view” (hand behind head) xray ii) Greater Tuberosity #: Magnitude of fracture defect may be overestimated due to concurrent, unrecognised Hill-Sachs Associated with longitudinal tears in rotator cuff (which attach to greater tuberosity) Often displaced Closed reduction of shoulder may reduce fracture (NB if this # occurs in isolation often requires open reduction) iii) Head of humerus # iv) Neck of humerus # SCAPULA i) Anterior Glenoid Compression or avulsion seen in up to 30% of 1st dislocations ii) Coracoid iii) Acromion 2) CARTILAGE/CAPSULE/MUSCLE i) Bankart: Up to 90% of 1st dislocations Avulsion of the anteroinferior glenoid labrum at its attachment to IGHL complex In up to 30% of patients the IGHL will heal in a redundant position ii) SLAP tear: 5-7% of 1st dislocations “Superior Labrum Anterior Posterior” tear from sup aspect labrum ( anteriorly May involve long head biceps (ie can detach) Also seen in throwing athletes, FOOSH blunt trauma “detachment lesion of th