1. Shoulder Dislocations
Ben Savage

2. Objectives
 The Shoulder
 What is a shoulder dislocation
 Types of dislocation
 Classification of injury
 Risk Factors
 Prevention
 Clinical Signs and Symptoms
 Tests
 Treatment
 Reduction
 Prognosis

3. The Shoulder (anon (b), 2009)
 Ball and socket joint
 3 joint

Glenohumeral

Acromioclavicular

Sternoclavicular
 Very mobile but also very unstable
 Stabilised by rotator cuff muscles

Infraspinatus

Supraspinatus

Teres minor

Subscapularis

4. What is a Shoulder Dislocation
 Shoulder Dislocation is when the head of
the humerus separates from the scapula at
the glenohumeral joint. (Anon (a), 2009)

5. (Wesley Norman,2009)

6. X-ray shows an anterior dislocation of the shoulder
(ROLANDO REYNA , 2009)

7. Types of Dislocation (ROLANDO REYNA,
2009)
 Anterior - 95%

Sub-coracoid

Sub-glenoid

Sub-clavicular
 Posterior - 4%
 Inferior - <1%

8. Classification of injury to AC joint (Moira
Davenport et al, 2009)
 The Rockwood classification is as follows:
 Type I - Minor sprain of AC ligament, intact joint capsule, intact CC
ligament, intact deltoid and trapezius
 Type II - Rupture of AC ligament and joint capsule, sprain of CC ligament
but CC interspace intact, minimal detachment of deltoid and trapezius
 Type III - Rupture of AC ligament, joint capsule, and CC ligament; clavicle
elevated (as much as 100% displacement); detachment of deltoid and trapezius
 Type IV - Rupture of AC ligament, joint capsule, and CC ligament; clavicle
displaced posteriorly into the trapezius; detachment of deltoid and trapezius
 Type V - Rupture of AC ligament, joint capsule, and CC ligament; clavicle
elevated (more than 100% displacement); detachment of deltoid and trapezius
 Type VI (rare) - Rupture of AC ligament, joint capsule, and CC ligament;
clavicle displaced behind the tendons of the biceps and coracobrachialis

9. Risk Factors
 Age – Bimodal peaks
 Race – None
 Congenital
 Activity ~95% due to trauma
 Previous dislocation/ trauma

10. Prevention
 Protection of shoulder joint
 Build up muscles around joint
 Don’t take part in high risk activities

11. History (Sharon R Wilson et al 2009)
 Hx is crucial.
 Mechanism of injury
 Position of arm at time of injury

Anterior – arm abducted and externally rotated

Posterior – arm adducted and internally rotated

Inferior – arm fully abducted and elbow often flexed
on or behind head

12. Clinical Signs and Symptoms (Daniel
Marsland et al, 2008)
 OE:
 Loss of normal contour
 Complains of severe shoulder pain
 Range of movement decreased in the joint
 Palpable humoral head
 Positive Apprehension test

13. Tests
 USS
 X-ray
 Duplex scan or arteriogram
 MRI

14. Treatment (Daniel Marsland et al, 2008)
 PRN analgesia and muscle relaxants
 Reduction (with neuro exam pre and post)
 Immobilisation of limb for 3-5 day
 Rehab physiotherapy
 If complex dislocation or recurrent
dislocation consider surgery

15. Reduction
 Many different methods
 Basic principles (Patricia Rivera et al (b) 2009)
 Flex arm to 90 degrees
 External rotation of humerus
 Contraindications (Patricia Rivera et al (a) 2009)
 Subclavicular/ intrathorasic disolcation
 Suspicion of major vessel damage. 6P’s
 Pale, Pulseless, Unreasonable Pain, Paralysed, Paraesthetic, Perishing
with cold
 Fractures

16. Prognosis (Moira Davenport, MD et al 2009)
 Approximately 80-94% of patients younger than 20 years
at the time of the initial dislocation have a recurrence.
 Of patients younger than 40 years, 26-48% develop
recurrent dislocation.
 Dislocation recurs in only 0-10% of patients older than
40 years.
 Minor trauma that results in a dislocation is associated
with an 86% recurrence rate.

17. References
 Wesley Norman http://home.comcast.net/~wnor/radiographsul.htm
8/2/09
 Daniel Marsland and Sabrina Kapoor. p178-180 Crash course 2nd
edition, Rheumatology and Orthopaedics, 2008
 Anon(a). http://en.wikipedia.org/wiki/Dislocated_shoulder 8/2/09
 http://newsimg.bbc.co.uk/media/images/41807000/jpg/_41807514_3ru
gby.jpg 8/2/09
 Anon(b) http://en.wikipedia.org/wiki/Shoulder 9/2/09
 Patricia Rivera et al (a),
http://emedicine.medscape.com/article/109130-overview 9/2/09
 Patricia Rivera et al (b),
http://emedicine.medscape.com/article/109130-treatment 9/2/09

18. References
 Moira Davenport, MD et al
http://emedicine.medscape.com/article/822269-overview 9/2/09
 ROLANDO REYNA M.D. http://www.mskcases.com/index.php?
module=article&view=47 9/2/09
 L. Edward Seade, MD http://emedicine.medscape.com/article/93323-
overview 9/2/09
 Sharon R Wilson, MD et al
http://emedicine.medscape.com/article/823843-overview 9/2/09

19. Thank you for listening
Any Questions