Shoulder ACJ & elbow dislocations

كسووووووووور دكتور وهبي
Shoulder , Acromioclavicular & Elbow Dislocations
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
Wahby Ghalib10



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 injury
Vascular 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

Wahby Ghalib26

Recurrent dislocation

Hill – Sachs lesion
Bankart 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 sign
Scapular lateral
Axillary 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 exercise
III : 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