Posterior shoulder dislocation: Difference between revisions
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==Background== | ==Background== | ||
*Accounts for 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> | *Accounts for 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> | ||
*Mechanism of injury - forceful internal rotation/adduction (secondary to e.g. seizure, electric shock) or blow to | *Mechanism of injury - forceful internal rotation/adduction (secondary to e.g. seizure, electric shock) or blow to anterior shoulder | ||
*Neurovascular and rotator cuff tears are less common than in | *Neurovascular and rotator cuff tears are less common than in anterior dislocations | ||
==Clinical Features== | ==Clinical Features== | ||
*Prominence of posterior shoulder and | *Prominence of posterior shoulder and anterior flattening of normal shoulder contour | ||
*Patient unable to rotate or abduct affected arm | *Patient unable to rotate or abduct affected arm | ||
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*Post-reduction X-ray | *Post-reduction X-ray | ||
*Apply sling | *Apply sling | ||
*'''Note: Do not reduce chronic dislocations (>4 weeks) in the ED due to risk of arterial injury''' - consult ortho for open reduction | |||
==Disposition== | ==Disposition== | ||
Revision as of 17:40, 13 July 2017
Background
- Accounts for 2-4% of shoulder dislocations[1]
- Mechanism of injury - forceful internal rotation/adduction (secondary to e.g. seizure, electric shock) or blow to anterior shoulder
- Neurovascular and rotator cuff tears are less common than in anterior dislocations
Clinical Features
- Prominence of posterior shoulder and anterior flattening of normal shoulder contour
- Patient unable to rotate or abduct affected arm
Differential Diagnosis
Shoulder and Upper Arm Diagnoses
Traumatic/Acute:
- Shoulder Dislocation
- Clavicle fracture
- Humerus fracture
- Scapula fracture
- Acromioclavicular joint injury
- Glenohumeral instability
- Rotator cuff tear
- Biceps tendon rupture
- Triceps tendon rupture
- Septic joint
Nontraumatic/Chronic:
- Rotator cuff tear
- Impingement syndrome
- Calcific tendinitis
- Adhesive capsulitis
- Biceps tendinitis
- Subacromial bursitis
- Cervical radiculopathy
Refered pain & non-orthopedic causes:
- Referred pain from
- Neck
- Diaphragm (e.g. gallbladder disease)
- Brachial plexus injury
- Axillary artery thrombosis
- Thoracic outlet syndrome
- Subclavian steal syndrome
- Pancoast tumor
- Myocardial infarction
- Pneumonia
- Pulmonary embolism
Evaluation
- Plain film X-ray
- Scapular "Y" view shows humeral head in posterior position
- 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
- Bedside ultrasound can be used to assess for both dislocation and successful reduction
Management
- Reduce
- Consider procedural sedation
- Traction applied to adducted arm in long axis of humerus
- Assistant pushes humeral head anteriorly into glenoid fossa
- Post-reduction X-ray
- Apply sling
- Note: Do not reduce chronic dislocations (>4 weeks) in the ED due to risk of arterial injury - consult ortho for open reduction
Disposition
- Discharge after reduction
- Ortho follow-up
See Also
External Links
References
- ↑ Grate I Jr. Luxatio erecta: a rarely seen, but often missed shoulder dislocation. Am J Emerg Med. 2000 May;18(3):317-21.