Shoulder dislocation

Background

• Humerus separates from the scapula at the glenohumeral joint.
• Partial dislocation of the shoulder is referred to as subluxation.

Types

• Anterior shoulder dislocation
• Posterior shoulder dislocation
• Inferior shoulder dislocation

Diagnosis

• Plain film X-ray

Differential Diagnosis

Shoulder and Upper Arm Diagnoses

Traumatic/Acute:

• Shoulder Dislocation
  • Anterior shoulder dislocation
  • Posterior shoulder dislocation
  • Inferior shoulder dislocation
• Clavicle fracture
• Humerus fracture
• Scapula fracture
• Acromioclavicular joint injury
• Glenohumeral instability
• Rotator cuff tear
• Biceps tendon rupture
• Triceps tendon rupture
• Septic joint

Nontraumatic/Chronic:

• Rotator cuff tear
• Impingement syndrome
• Calcific tendinitis
• Adhesive capsulitis
• Biceps tendinitis
• Subacromial bursitis
• Cervical radiculopathy

Refered pain & non-orthopedic causes:

• Referred pain from
  • Neck
  • Diaphragm (e.g. gallbladder disease)
• Brachial plexus injury
  • Rucksack paralysis
• Axillary artery thrombosis
• Thoracic outlet syndrome
• Subclavian steal syndrome
• Pancoast tumor
• Myocardial infarction
• Pneumonia
• Pulmonary embolism

Management

• Reduction
  • See individual types for specific techniques.

• Cochrane review notes lower complications, equal pain control, and shorter ED stay with intra-articular lidocaine vs. procedural sedation
  • 20 mL of 1% lidocaine intra-articular injection

Disposition

• Uncomplicated dislocation can be discharged after reduction.
• See individual types for specific management.

See Also

• Shoulder diagnoses

External Links

• Good all-round shoulder reduction technique lecture
• Keeping Up in EM Shoulder Reduction Video

Video

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