Shoulder ACJ & elbow dislocations

Shoulder , Acromioclavicular & Elbow Dislocations

Dr. Wahby Ghalib CABMS, FJMC, MRCS

Shoulder Dislocation

Why liable?

Wide ROM Shallow glenoid

Supportive structures

Rotator cuff Ligaments Labrum

The least supported is the inferior aspect

Types

Anterior 95% Posterior 2% Inferior (luxatio erecta) Multidirectional

Anterior dislocation

Mechanism

Abduction + extension + external rotation

CF

The lateral outline of the shoulder is flattened

XR

AP Scapular lateral Axillary lateral

Reduction

Hippocratic method Stimson method Kocher method

After reduction

XR Test active abduction NV examination Arm sling

Complications

Early


Rotator cuff tear Nerve injuryVascular injury# dislocation all these are more common with ↑ age

Late

Recurrent dislocation : commonest cx 85% < 20y , 15% > 40y Missed dislocation

Recurrent dislocation

Apprehension test Drawer test

Recurrent dislocation

Hill – Sachs lesionBankart lesion

Recurrent dislocation

Surgery is indicated if ≥ 3 times per year

Posterior dislocation

Mechanism

Adduction + IR Convulsion Electric shock


CF

Arm in IR

XR

Usually missed AP  electrical bulb signScapular lateralAxillary lateral

Reduction

Traction in adduction then IR

Acromioclavicular joint injury

Mechanism

Fall on the shoulder with arm adducted

Types

I : sprain of the AC ligament II : subluxation III : dislocation


XR

AP view AP stress view

Rx



I & II : arm sling  exerciseIII : if pt is young or demanding occupation  repair of the CC ligament + CC screw

Complications

RC syndrome Missed dislocation Ossification of ligaments OA

Elbow dislocation

Fall on outstretched hand Posterior or posterolateral Simple or complex

Reduction

Traction Gradual flexion



Don`t immobilize the elbow > 3w

Thanks