Shoulder dislocation is a very painful injury caused by the collision with an object or hard fall or any others. The shoulder dislocation occurs when scapula separated from humerus at the shoulder joint. The shoulder joint is commonly dislocated for its wide range of movement, shallowness of the glenoid, laxity of the capsule and for the fact that integrity of the joint depends on the protection of the surrounding muscles. There are three different types of shoulder dislocation, of which the first is much the commoner
Sub glenoid Dislocation — This is a rare type and occurs when the head can manage to keep itself below the glenoid.
Posterior (subacromial or subspinous type)— This may result either from a direct backward trauma on the head, e.g. fall on the front of the shoulder, or a forced internal rotation of the adducted arm.
Anterior Dislocation (sub-coracoid type)—This means that the head of the humerus is displaced anterior to the shoulder joint. This result in two ways - either due to a fall on the outstretched hand or due to a fall on the abducted arm.
Important Clinical Features:
Loss of function.
History of violence.
Arm in abduction, opposite hand supports the elbow.
Shoulder - flattened with loss of resistance.
Limitation of movements of the shoulder.
Line of the arm passes medial to the glenoid.
Head palpable beneath the coracoid process.
Shortening of the arm.
Abnormal prominence at the head of the humerus.
The most obvious sign in posterior dislocation is fixed the internal rotation of the arm.
Callaway's test — increased vertical circumstance of the axilla.
Dugas test —unable to touch the other shoulder with the injured limb. (16) X-ray confirms the diagnosis.
Hamilton's Ruler Test — A ruler touches the lateral epicondyle and the acromion.
Management of Shoulder Dislocation: On spot — immobilisation, sedation. During ambulation — drip (if necessary). At emergency — screening.
Prophylaxis — A.T.S. /A.G.S. Casting, X-ray, diagnosis.
Shoulder Dislocation Treatment:
](i) At O.T. after pre-operative preparation (under G.A. or short anaesthesia).
(ii) Anterior dislocation - Ig 300 abduction of arm firm traction of humerus and arm steadily rotated outward by moving forearm. Then forearm is rotated inwards to bring the hand on the healthy shoulder. (iii) Adhesive strapping and bandaging and a sling to support the limb. The distal free joints are moved from the beginning, active shoulder movements after three weeks.
(iv) Posterior dislocation — reduction by traction and outward rotation of the limb. (e) Immobilisation in external rotation in a plaster spica for three weeks. Active exercise afterwards.
Nerve injury involving circumflex and radial nerves, cords or brachial plexus.
Fractures of the greater tuberosity, head, anatomical neck, surgical neck, glenoid rim and acromion.
Home Remedies for Shoulder pain: