Shoulder dislocation
Revision as of 04:32, 18 February 2015 by Rossdonaldson1 (talk | contribs)
Background
- Cochrane review notes lower complications, equal pain control, and shorter ED stay with intra-articular lidocaine vs. procedural sedation
- 20mL of 1% lidocaine intra-articular injection
Types
Posterior Dislocation
Background
- Via forceful internal rotation/adduction (sz, electric shock) or blow to ant shoulder
- Neurovascular and rotator cuff tears are less common than in ant dislocations
Clinical Features
- Prominence of posterior shoulder and ant flattening of normal shoulder contour
- Pt unable to rotate or abduct affected arm
Imaging
- Scapular "Y" view shows humeral head in posterior position
Management
- Reduce
- Traction applied to adducted arm in long axis of humerus
- Assistant pushes humeral head anteriorly into glenoid fossa
- Spling, ortho f/u
Inferior Dislocation
Background
- Assoc w/ significant soft tissue trauma or fracture
- Via hyperabduction force which levers the humeral neck against the acromion
Clinical Features
- Pt p/w humerus fully abducted with hand on or behind the head
- Humeral head can be palpated on lateral chest wall
Management
- Reduce
- Traction in upward and outward direction
- Sling, ortho f/u (rotator cuff tear is the norm)
Further Reading
Good all-round shoulder reduction technique lecture
Keeping Up in EM Shoulder Reduction Video
References
- Tintinalli
- Roberts:Clinical Procedures in EM. 5th ed
- https://www2.aofoundation.org/wps/portal/!ut/p/c0/04_SB8K8xLLM9MSSzPy8xBz9CP0os3hng7BARydDRwN3QwMDA08zTzdvvxBjIwN_I_2CbEdFADiM_QM!/?redfix_url=&implantstype=&segment=Proximal&bone=Humerus&classification=11-A1.3&showPage=redfix&treatment=Operative&method=Closed%20reduction%3B%20screw%20fixation