2. Dislocation of Shoulder
- 1. Dislocation of Shoulder By:- Dr. Bindesh D. Patel, PT Deputy Registrar P P Savani University
- 2. Mechanism • As it is very incongruent joint, it is very common to dislocate • FOOSH injury • Occassionally thorugh direct hitting • Epileptic convulsion and electric shock
- 5. Bankart’s lesion • Stripping of glenoid labrum along with periosteum from ant-inf surface. • Head comes in front of the scapular neck Hill-sachs lesion • It is a depression on the humeral head in its postero lateral quadrant • Caused by anterior edge of the glenoid of the glenoid Rounding off • Rounding off of the anterior glenoid rim occurs
- 9. Diagnosis • History – Patient’s shoulder is supported in adduction and elbow supported with the opposite hand. – History of fall – Pain and inability to move the shoulder
- 10. • On examination in anterior dislocation – Normal round contour is lost – Fullness below clavicle can be felt due to displaced hand. Can be confirmed by rotating hand – Dugas test :- inability to touch opposite shoulder – Hamilton ruler test :- Ruler can be placed on lateral side of shoulder. This touches acromion process and lateral condyle of humerus simultaneously.
- 12. • On examination in posterior dislocation – Loss of external rotation. Injury is often missed in x-ray.
- 13. Treatment • Treatment of acute dislocation is reduction under sedation or general anesthesia, followed by immobilization of the shoulder in chest arm bandage for 3 weeks.
- 14. • Techniques of reduction of shoulder dislocation • Kocher’s maneuver :- Traction is applied along with long axis of humerus Arm is rotated externally Arm is adducted by carrying the elbow across the body towards the midline Arm is rotated internally so that hand falls across the opposite shoulder
- 16. • Hippocrates maneuver :- Surgeon applies firm and steady pull on semi- abducted arm He keeps foot in axilla against the chest wall Head of humerus is levered back into position using the foot as fulcrum
- 18. Complication • Early complication – Injury to axillary nerve • Late complication – Recurrent dislocation may be due to 1. Anatomically unstable joint e.g. Marfan’s syndrome 2. Inadequate healing after first dislocation 3. An epileptic patient.
- 19. Treatment • Putti – plate operation
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