Shoulder dislocation: Difference between revisions

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{{Shoulder dislocation}}
{{Shoulder dislocation}}
{{CMG}}; '''Associate Editors-In-Chief:''' Jumana Nagarwala, M.D., Senior Staff Physician, Department of Emergency Medicine, Henry Ford Hospital and {{CZ}}
{{CMG}}; {{AE}} Jumana Nagarwala, M.D., Senior Staff Physician, Department of Emergency Medicine, Henry Ford Hospital; {{CZ}}
==Overview==
In posterior dislocation, the humeral head is forced posteriorly in internal rotation. Posterior dislocations account for 2%–4% of all shoulder dislocations. In adults, convulsive disorder is the most common cause. Electrocution is a classic but uncommon cause of posterior shoulder dislocation. Bilateral dislocations are not infrequent.


Anterior dislocation is usually the result of direct or indirect trauma, with the arm forced into abduction and external rotation. It is the most frequent type of shoulder dislocation (represents more than 90% of injuries).
==[[Shoulder dislocation overview|Overview]]==


==Pathophysiology==
==[[Shoulder dislocation historical perspective|Historical Perspective]]==
===Associated Conditions===
 
** Hill-Sach lesions (describes a characteristic defect of the posterolateral surface of the humeral head, and represents a compression fracture)
==[[Shoulder dislocation classification|Classification]]==
** Labral lesions (i.e., Bankart lesion)
 
** Bony glenoid lesions - Osseous anterior glenoid rim fractures (44%), bony Bankart lesions, fracture of the greater tuberosity
==[[Shoulder dislocation pathophysiology|Pathophysiology]]==
** Intraarticular loose body
 
** Rotator cuff lesions - Supraspinatus tears or subscapularis tears
==[[Shoulder dislocation causes|Causes]]==
 
==[[Shoulder dislocation differential diagnosis|Differentiating Shoulder Dislocation from other Conditions]]==
 
==[[Shoulder dislocation epidemiology and demographics|Epidemiology and Demographics]]==
 
==[[Shoulder dislocation risk factors|Risk Factors]]==
 
==[[Shoulder dislocation natural history, complications and prognosis|Natural History, Complications and Prognosis]]==


==Diagnosis==
==Diagnosis==
===X Ray===


*Posterior dislocation may be missed initially on frontal radiographs in 50% of cases.
[[Shoulder dislocation history and symptoms|History and Symptoms]] | [[Shoulder dislocation physical examination|Physical Examination]] | [[Shoulder dislocation laboratory findings|Laboratory Findings]] | [[Shoulder dislocation x ray|X Ray]] | [[Shoulder dislocation CT|CT]] | [[Shoulder dislocation MRI|MRI]] | [[Shoulder dislocation ultrasound|Ultrasound]] | [[Shoulder dislocation other imaging findings|Other Imaging Findings]] | [[Shoulder dislocation other diagnostic studies|Other Diagnostic Studies]]
*Signs on frontal radiographs are subtle, including the trough line sign and the loss of normal "half-moon overlap".
*Axillary, scapular Y, or posterior oblique projections are needed for confirmation.
*The absence of external rotation on images in a standard shoulder series is a clue to posterior dislocation.
*Loss of half-moon overlap: On a normal true anteroposterior image, there is a half-moon overlap between the humeral head and the glenoid. In a posteriorly dislocated shoulder, there is lateral displacement of the humeral head with respect to the glenoid (losing the half-moon overlap)
*Trough line sign: In posterior dislocation, the anterior aspect of the humeral head becomes impacted against the posterior glenoid rim. With sufficient force, this causes a compression fracture on the anterior aspect of the humeral head. This compression fracture is analogous to the Hill-Sachs compression fracture seen with anterior dislocation of the glenohumeral joint. Frontal radiographs reveal two nearly parallel lines in the superomedial aspect of the humeral head.
----
;Shown below are the X ray findings of posterior shoulder dislocation.
{|
|-
| [[Image:Posterior-shoulder-fracture-001.jpg| 150px]]
| [[Image:Posterior-shoulder-fracture-002.jpg| 150px]]
| [[Image:Posterior-shoulder-fracture-003.jpg| 150px]]
|}


Courtesy: RadsWiki, copyleft source
==Treatment==
----


;Shown below are the X ray findings of anterior shoulder dislocation.
[[Shoulder dislocation medical therapy|Medical Therapy]] | [[Shoulder dislocation surgery|Surgery]] | [[Shoulder dislocation primary prevention|Primary Prevention]] | [[Shoulder dislocation secondary prevention|Secondary Prevention]] | [[Shoulder dislocation cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Shoulder dislocation future or investigational therapies|Future or Investigational Therapies]]
{|
|-
| [[Image:Anterior-shoulder-dislocation-001.jpg|150px]]
| [[Image:Anterior-shoulder-dislocation-002.jpg|150px]]
| [[Image:Anterior-shoulder-dislocation-003.jpg|150px]]
|}


Courtesy: RadsWiki, copyleft source
==Case Studies==
----
;Shown below are the X ray findings of anterior shoulder dislocation post reduction.
{|
|-
| [[Image:Anterior-shoulder-dislocation-004.jpg|150px]]
| [[Image:Anterior-shoulder-dislocation-005.jpg|150px]]
| [[Image:Anterior-shoulder-dislocation-006.jpg|150px]]
|}


Courtesy: RadsWiki, copyleft source
[[Shoulder dislocation case study one|Case #1]]


==References==
{{reflist|2}}


[[Category:Orthopedics]]
[[Category:Orthopedics]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]


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Latest revision as of 13:06, 4 March 2013

Shoulder Dislocation Microchapters

Home

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Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Shoulder Dislocation from other Conditions

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Jumana Nagarwala, M.D., Senior Staff Physician, Department of Emergency Medicine, Henry Ford Hospital; Cafer Zorkun, M.D., Ph.D. [2]

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Shoulder Dislocation from other Conditions

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | X Ray | CT | MRI | Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1


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