Dislocations

Shoulder Dislocations

  • Head of humerus dislocates from glenoid
  • GHJ (Glenohumeral Joint) is stabilised by capsule (series of ligaments) and labrum as well as surrounding muscles 
  • When labrum or ligaments tear – instability and increased likelihood of dislocation
  • Dislocations can happen anteriorly, posteriorly and inferiorly. Anterior dislocation being the most common
  • Can be traumatic or atraumatic

 

dislocation

Radiographs demonstrating the bilateral anterior shoulders dislocation with fracture greater tuberosity left side

 

Subjective Assessment

  • Traumatic – forceful injury eg. rugby tackle, RTA. Usually first episode
  • Atraumatic – minimal force involved eg. reaching up, turning in bed
  • Positional non-traumatic – dislocate with no history of trauma eg. ‘party trick’

Objective Assessment

  • Traumatic – pain+, visible deformity, swelling, bruising
  • Atraumatic – pain settling, usually relocates by itself or with a little help, general hypermobility
  • Positional non-traumatic – generalised ache, relocated easily, often bilateral

Management 

  • Traumatic – usually needs reducing in A&E, use of a sling. Referral to physiotherapy as appropriate. If the patient reports trauma but has not been to A&E please refer to T&O (See shoulder pathway)
  • Atraumatic – normally does not require relocating in A+E.  Referral for physiotherapy indicated where treatment may include work to restore balance of muscle control and improve shoulder stability; usually very effective 
  • Where conservative management has failed orthopaedic referral may be indicated.
  • Positional non-traumatic – usually as a result of abnormal muscle patterning. Therefore,  main treatment is physiotherapy to re-educate muscles through strengthening exercises to prevent further dislocations

 

References

  • Image from OpenI – Licensed by CC
  • Image from OpenI – Licensed by CC

close
Select font size
Site colour