Dislocation of Upper Limb

♥ Complete loss of articulation
between the two opposing
surfaces of a joint.
♥ Incomplete dislocation
= subluxation
Definition:

♥ Congenital : - CongenitalCongenital : - Congenital
dislocation of hipdislocation of hip
♥ Pathological : - polioPathological : - polio
- infection- infection
♥ Traumatic : tear ofTraumatic : tear of
ligaments and capsuleligaments and capsule
Types:

Clinical picture
♥ Severe painSevere pain
♥ Loss of movementsLoss of movements
♥ Abnormal position of the limbAbnormal position of the limb
♥ Altered bony landmarksAltered bony landmarks

Treatment
♥ Urgent reduction :Urgent reduction :
Under GeneralUnder General
AnesthesiaAnesthesia
♥ SplintageSplintage
( fixation )( fixation )

Complications
♥ Nerve injuries:Nerve injuries:
- shouldershoulder ::
axillary N.axillary N.
- hiphip : sciatic N.: sciatic N.

♥ Vascular injuries:Vascular injuries:
♥ Recurrent dislocations : (Recurrent dislocations : ( shouldershoulder ++)++)
♥ Avascular Necrosis and OsteoarthritisAvascular Necrosis and Osteoarthritis
♥ Joint stiffness :Joint stiffness :
-- adhesionsadhesions
-- myositis ossificansmyositis ossificans

Dislocations of specific joints
♥ ShoulderShoulder
♥ ElbowElbow
♥ HipHip
♥ Knee injuriesKnee injuries

Shoulder Dislocation
It is the most commonlyIt is the most commonly
affected joint due to :affected joint due to :
♥ Wide range of movementsWide range of movements
♥ Shallow glenoidShallow glenoid
♥ Weak capsuleWeak capsule
♥ 45% of dislocations.
** Usually anterior dislocationUsually anterior dislocation

Clinical picture
♥ Severe pain and loss ofSevere pain and loss of
movementsmovements
♥ Arm abductedArm abducted
♥ Loss of rounded contour ofLoss of rounded contour of
the shoulderthe shoulder
♥ Prominent acromionProminent acromion
♥ Humeral head locatedHumeral head located
sub- coracoid .sub- coracoid .

normal shoulder dislocated shouldernormal shoulder dislocated shoulder

Treatment
♥ Urgent reductionUrgent reduction
U.G.A.U.G.A.
♥ Strapping :Strapping :
to allow healing of theto allow healing of the
torn labrum and capsule.torn labrum and capsule.

Complications
♥ Neuro -vascular injuries:Neuro -vascular injuries:
axillary N.axillary N.
♥ Recurrent Dislocation :Recurrent Dislocation :
if not treated adequately atif not treated adequately at
first.first.

Recurrent anterior dislocation of the shoulderRecurrent anterior dislocation of the shoulder
Inadequate ttt. of the firstInadequate ttt. of the first
dislocation usually leads to :dislocation usually leads to :
♥ Persistent avulsion of thePersistent avulsion of the
labrum (labrum (Bankart lesion )
♥ Redundant capsule andRedundant capsule and
gleno-humeral lig.gleno-humeral lig.
♥ A posterolateral head defect is
caused by an impression
fracture on the glenoid rim
(Hill-Sachs lesion )

CLINICALLYCLINICALLY::
**
♥ Easy, repeatedEasy, repeated
dislocation.dislocation.
♥ Patient canPatient can
reduce it easily.reduce it easily.
• Hill-Sachs lesion

Treatment of recurrent dislocationTreatment of recurrent dislocation
shouldershoulder::
♥ Fixation of theFixation of the
avulsed glenoidavulsed glenoid
labrum.labrum.
♥ Tightening of the laxTightening of the lax
capsule.capsule.
Surgically , or betterSurgically , or better
arthroscopicallyarthroscopically ..

Dislocation of the Elbow
♥ Usually posterior :Usually posterior :
with or without fr.with or without fr.
coronoid.coronoid.
♥ Rarely anterior :Rarely anterior :
with fr. olecranon.with fr. olecranon.
♥ Sometimes lateral orSometimes lateral or
medialmedial

Clinically:
♥ Pain, loss ofPain, loss of
movementsmovements
♥ Altered bonyAltered bony
landmarks.landmarks.

Treatment:
♥ Reduction under generalReduction under general
anesthesiaanesthesia
♥ Splintage : by post. plaster slabSplintage : by post. plaster slab
COMPLICATIONSCOMPLICATIONS ::
♥ Myositis ossificansMyositis ossificans

Treatment of neglected dislocation
♥ ArthrodesisArthrodesis
♥ Arthroplasty :Arthroplasty :
- interposition arthroplasty- interposition arthroplasty
- replacement arthroplasty- replacement arthroplasty

Dislocation of the Hip
♥ UsuallyUsually posteriorposterior ::
due to severe traumadue to severe trauma
to flexed hip & knee [dash-to flexed hip & knee [dash-
board accidents].board accidents].
♥ AnteriorAnterior dislocation :dislocation :
very rare.very rare.
♥ CentralCentral dislocation :dislocation :
associated with fr.associated with fr.
acetabulum.acetabulum.

Anterior Dislocation of the Hip

Central dislocation
[ Fracture acetabulum]

Clinical picture
♥ Severe pain & loss ofSevere pain & loss of
movements.movements.
♥ Flexion, adduction, andFlexion, adduction, and
internal rotationinternal rotation
of the affected limb.of the affected limb.
♥ Femoral head felt in theFemoral head felt in the
gluteal region.gluteal region.
♥ Absent femoral pulse.Absent femoral pulse.

Complications
♥ Early :Early :
Sciatic nerve injury.Sciatic nerve injury.
♥ Late :Late :
AVN of the femoral head,AVN of the femoral head,
leading to O.A. of the hip .leading to O.A. of the hip .

Treatment
♥ Recent :Recent :
- urgent reduction U.G.A.- urgent reduction U.G.A.
- splintage [ skin traction ].- splintage [ skin traction ].
♥ Neglected cases with AVN and O.A. :Neglected cases with AVN and O.A. :
- arthrodesis [ in young patients].- arthrodesis [ in young patients].
- Total Hip Replacement- Total Hip Replacement
( T.H.R.)( T.H.R.) [ in older age ] .[ in older age ] .

Knee InjuriesKnee Injuries
♥ Common in contact sports, football, andCommon in contact sports, football, and
accidents.accidents.
♥ Many structures inside, give the sameMany structures inside, give the same
symptoms :symptoms :
-- pain & tenderness.pain & tenderness.
-- swelling [ effusion ] .swelling [ effusion ] .
-- instability .instability .
-- limitation of movements.limitation of movements.

Internal Derangement of the
Knee ( I.D.K. (
Lesions causing pain or instability of the knee.Lesions causing pain or instability of the knee.
♥ Meniscal injuries :Meniscal injuries :
-- medialmedial
-- laterallateral
♥ Cruciate ligaments :Cruciate ligaments :
-- anterior [ A.C.L.]anterior [ A.C.L.]
-- posterior [ P.C.L.]posterior [ P.C.L.]
♥ Collateral ligaments :Collateral ligaments :
-- medialmedial
-- laterallateral

Diagnosis of Knee Injuries
♥ History : traumaHistory : trauma
♥ Clinical examination :Clinical examination :
-- inspectioninspection
-- palpationpalpation
-- special clinical testsspecial clinical tests
♥ Special investigations :Special investigations :
-- x-rayx-ray
-- M.R.I.M.R.I.
-- aspiration of effusionaspiration of effusion
and haemarthrosisand haemarthrosis

Special clinical tests for
diagnosis of knee injuries
♥ Meniscal lesions :Meniscal lesions :
-- Mc Murray’s test .Mc Murray’s test .
♥ Cruciate ligaments :Cruciate ligaments :
-- anterior & posterioranterior & posterior
drawer testsdrawer tests
♥ Collateral ligaments :Collateral ligaments :
-- varus & valgusvarus & valgus
stress tests .stress tests .

Treatment of knee injuries
♥ Mild casesMild cases ( sprains(( sprains( ::
-- conservative ttt. : bandage orconservative ttt. : bandage or
plaster cast +plaster cast + med. ttt.med. ttt.
♥ Severe casesSevere cases ( tears (( tears ( ::
-- surgical ttt. :surgical ttt. :
** menisci : - repairmenisci : - repair
- excision- excision
** ligaments :ligaments :
- early repair- early repair
- late reconstruction.- late reconstruction.

Surgical interference is mostlySurgical interference is mostly
arthroscopicarthroscopic
♥ Arthroscopy can beArthroscopy can be
used for bothused for both
diagnostic anddiagnostic and
therapeutictherapeutic
purposes.purposes.

Dislocation of Upper Limb

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