Posterior shoulder dislocation - Revision history

Elcatracho: /* Background */

2021-02-13T17:53:13Z

Background

← Older revision		Revision as of 17:53, 13 February 2021
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	*Complications (neurovascular injuries and rotator cuff tears) less common than in anterior dislocation		*Complications (neurovascular injuries and rotator cuff tears) less common than in anterior dislocation
	*May go undetected for extended period as often missed on physical exam and imaging		*May go undetected for extended period as often missed on physical exam and imaging
			*Classically associated with [[seizures]] and [[Lightning injuries\|lightning strikes]]

	{{Shoulder dislocation types}}		{{Shoulder dislocation types}}

Rossdonaldson1: /* Management */

2020-06-22T20:27:28Z

Management

← Older revision		Revision as of 20:27, 22 June 2020
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	#Apply shoulder immobilizer		#Apply shoulder immobilizer
	#Obtain post-reduction radiographs		#Obtain post-reduction radiographs
	*~~'''Note:~~ Do not reduce chronic dislocations ~~(>4 weeks)~~ in the ED due to risk of arterial injury~~''' -~~ consult ortho for open reduction
			===Indications for Surgery===
			*Lesser tuberosity displacement not reduced with reduction
			*Articular defect >25%
			*Dislocation >3 weeks
			**Do not reduce chronic dislocations in the ED due to risk of arterial injury; consult ortho for open reduction

	==Disposition==		==Disposition==

Rossdonaldson1: /* Management */

2020-06-22T20:26:11Z

Management

← Older revision		Revision as of 20:26, 22 June 2020
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	==Management==		==Management==
	*Closed reduction		===Closed reduction===
	**Most require [[procedural sedation]]		''Most require [[procedural sedation]]''
	#Adduct the arm		#Adduct the arm
	#Apply traction along long axis of humerus		#Apply traction along long axis of humerus

Rossdonaldson1: /* Disposition */

2020-06-22T20:24:48Z

Disposition

← Older revision		Revision as of 20:24, 22 June 2020
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	==Disposition==		==Disposition==
	*Discharge after successful reduction		*Discharge after successful reduction
	*~~Orthopedic surgery outpatient~~ follow-up		**Maintain [[sling +/- swath]] or shoulder immobilizer (shoulder in adduction and internal rotation) until seen in follow-up by orthopedic surgery
	*Any patient with a chronic dislocation requires orthopedic consult in the ED for consideration of operative reduction due to the risk of arterial injury		*Any patient with a chronic dislocation requires orthopedic consult in the ED for consideration of operative reduction due to the risk of arterial injury

Rossdonaldson1: /* Evaluation */

2020-06-22T20:24:01Z

Evaluation

← Older revision		Revision as of 20:24, 22 June 2020
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	**Lack of normal overlap of humeral head and glenoid fossa		**Lack of normal overlap of humeral head and glenoid fossa
	**"Light bulb sign" - fixed internal rotation makes for light bulb appearance of humeral head on AP		**"Light bulb sign" - fixed internal rotation makes for light bulb appearance of humeral head on AP
			*Consider CT for occult dislocations of evaluation of fractures
	*Bedside [[ultrasound: Joint\|ultrasound]] can be used to assess for both dislocation and successful reduction		*Bedside [[ultrasound: Joint\|ultrasound]] can be used to assess for both dislocation and successful reduction

Rossdonaldson1: /* Disposition */

2020-06-22T20:23:15Z

Disposition

← Older revision		Revision as of 20:23, 22 June 2020
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	*Orthopedic surgery outpatient follow-up		*Orthopedic surgery outpatient follow-up
	*Any patient with a chronic dislocation requires orthopedic consult in the ED for consideration of operative reduction due to the risk of arterial injury		*Any patient with a chronic dislocation requires orthopedic consult in the ED for consideration of operative reduction due to the risk of arterial injury

			==Complications==
			*[[Humerus fracture]] plus fracture of the posterior glenoid rim
			*Isolate fracture of lesser tuberosity
			*Reverse Hill-Sachs deformity
			**Impaction fracture of anteromedial humeral head

	==See Also==		==See Also==

Rossdonaldson1: /* Mechanism */

2020-06-22T20:21:16Z

Mechanism

← Older revision		Revision as of 20:21, 22 June 2020
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	*Forceful internal rotation and adduction		*Forceful internal rotation and adduction
	**Usually due to seizure or electric shock		**Usually due to seizure or electric shock
	***Consider in alcohol withdrawal, even without clear history of shoulder		***Consider in [[alcohol withdrawal]], even without clear history of shoulder injury
	*Blow to anterior shoulder		*Blow to anterior shoulder

Rossdonaldson1: /* Background */

2020-06-16T18:51:21Z

Background

← Older revision		Revision as of 18:51, 16 June 2020
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	==Background==		==Background==
			[[File:Gray326.png\|thumb\|Left shoulder and acromioclavicular joints with ligaments.]]
	[[File:Shoulder_joint_back-en.png\|thumb\|Shoulder anatomy, anterior.]]		[[File:Shoulder_joint_back-en.png\|thumb\|Shoulder anatomy, anterior.]]
	[[File:Shoulder joint back 05r4v.png\|thumb\|Shoulder anatomy, posterior.]]		[[File:Shoulder joint back 05r4v.png\|thumb\|Shoulder anatomy, posterior.]]

Rossdonaldson1: /* Mechanism */

2020-06-16T18:45:18Z

Mechanism

← Older revision		Revision as of 18:45, 16 June 2020
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	===Mechanism===		===Mechanism===
	**Forceful internal rotation and adduction		*Forceful internal rotation and adduction
	***Usually due to seizure or electric shock		**Usually due to seizure or electric shock
	****Consider in alcohol withdrawal, even without clear history of shoulder		***Consider in alcohol withdrawal, even without clear history of shoulder
	**Blow to anterior shoulder		*Blow to anterior shoulder

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1 at 18:42, 16 June 2020

2020-06-16T18:42:18Z

← Older revision		Revision as of 18:42, 16 June 2020
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	[[File:Shoulder joint back 05r4v.png\|thumb\|Shoulder anatomy, posterior.]]		[[File:Shoulder joint back 05r4v.png\|thumb\|Shoulder anatomy, posterior.]]
	*2-4% of shoulder dislocations<ref>Grate I Jr. Luxatio erecta: a rarely seen, but often missed shoulder dislocation. Am J Emerg Med. 2000 May;18(3):317-21.</ref>		*2-4% of shoulder dislocations<ref>Grate I Jr. Luxatio erecta: a rarely seen, but often missed shoulder dislocation. Am J Emerg Med. 2000 May;18(3):317-21.</ref>
	*Causes:
	**Forceful internal rotation and adduction
	***Usually due to seizure or electric shock
	****Consider in alcohol withdrawal, even without clear history of shoulder
	**Blow to anterior shoulder
	*Complications (neurovascular injuries and rotator cuff tears) less common than in anterior dislocation		*Complications (neurovascular injuries and rotator cuff tears) less common than in anterior dislocation
	*May go undetected for extended period as often missed on physical exam and imaging		*May go undetected for extended period as often missed on physical exam and imaging
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	*Anterior aspect of shoulder appears flattened		*Anterior aspect of shoulder appears flattened
	*Inability to rotate or abduct affected arm		*Inability to rotate or abduct affected arm

			===Mechanism===
			**Forceful internal rotation and adduction
			***Usually due to seizure or electric shock
			****Consider in alcohol withdrawal, even without clear history of shoulder
			**Blow to anterior shoulder

	==Differential Diagnosis==		==Differential Diagnosis==