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

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
References

Image from OpenI – Licensed by CC

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