A Family Doctor's Tale -DISLOCATION OF SHOULDER

DOC I HAVE DISLOCATION OF THE SHOULDER

Dislocation of Shoulder is a common injury of the Shoulder.
It is usually anterior in direction and results from a fall on the externally rotated abducted arm.


This forces the humerus out of the glenoid cavity of the shoulder blade into its anterior position.


Posterior dislocation is less common and may results from a force directed against the internally rotated arm.
It may occur during a seizure in patients with convulsive orders.

The cause of anterior Dislocation of Shoulder is:

Injury or trauma to the Shoulder bones from an anterior force directed on the externally rotated abducted arm.

The symptoms and signs of Dislocation of Shoulder are:

Symptoms:
1.Pain and deformity of the Shoulder

2.Acromial protrusion of the Shoulder joint
 
3.Absense of the normal fullness of the humeral head beneath the deltoid and acromial process

Signs:

1.Little and painful movement of the Shoulder

2.typically the other arm is holding on to the affected arm
 
3.With anterior dislocations the arn is held externally rotated, the shoulder is full and internal rotation is painful.

4. X-rays should be taken at different angles and will show usually dislocations of the humerus ball from its socket of the shoulder blade.
No fractures are seen if it is a pure dislocation

The complications of Dislocation of Shoulder are:

Deformity and loss of function of the Shoulder if left untreated.

The Treatment of Dislocation of Shoulder is:

Conservative treatment:
1.reduction of the dislocation is done under local anesthesia
No general anesthesia is needed.

2.Use a gentle steady straight traction on the arm with counter action on the shoulder.

3.Extend the Shoulder under traction to loosen the muscles

4.Flex the Shoulder slowly forward and keep it immobilized at 90 degree of flexion in a sling for 1 to 2 weeks to allow for ligaments and capsular healing.

5.Do another x-ray to check the position of the Shoulder joint and exclude fracture during reduction.

5.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) may be given for pain

6.Gentle range of movement exercises are instituted after symptoms have subsided

7.Temporary stiffness may be present and recovery may take a few months. Movements should never be forced

8.There should be a gradual return to normal movement

Another method of reduction is called the Stimson's method for anterior dislocation:
1.Patient is placed in a prone position on the bed with the affected arm hanging over the side of the bed.

2.A 5kg to 10 kg weight is tied to the wrist for traction.

3.As the shoulder muscle relax, spontaneous reduction frequently occurs.

4.The patient's shoulder is placed in a sling for 1 to 2 weeks to allow for ligaments and capsular healing and the shoulder joint immobilized until it recovers with rehabilitation.

Surgery :
1.Surgery is seldom necessary and requires open reduction under general or regional anesthesia

2.Surgery is also done for correction of recurrent dislocations of the shoulder.

These procedures usually restrict the rotation of the shoulder joint or reinforce the weakened shoulder joint capsule.

The prognosis of Dislocation of Shoulder is:

Prognosis is usually good .

Recurrences of dislocation of the shoulder can occur due to the loosening of the capsule of the shoulder and weakening of its ligaments.

The prevention of Dislocation of Shoulder is:

 Avoid any traumatic injury to Shoulder.