Shoulder dislocation

Background

• >99% are anterior dislocation assoc w/ indirect blow
• Must rule-out axillary nerve injury
• Consider intra-articular lidocaine (10-20mL) as alternative to procedural sedation

Clinical Features

• Arm held in abduction w/ shoulder lacking normal rounded contour
• Difficulty (painful) touching ipsilateral arm to contralateral shoulder

Imaging

• Prereduction radiographs advised for traumatic mechanism (rule-out fx-dislocation)
• AP
  • Will show dislocation
• Scapular lateral or "Y"
  • Will show whether dislocation is anterior or posterior

Reduction Techniques

• Traction-Countertraction

• Milch

• External Rotation

• • Types:
    • Subcoracoid
    • Subglenoid
    • Subclavicular
    • Intrathoracic

When the shoulder is anteriorly dislocated, two additional nerves, the axillary (supplying sensation to the lateral aspect of the shoulder) and the musculocutaneous (supplying sensation to the extensor aspect of the forearm), also should be checked.

• Dislocation + proximal humerus fx require ortho consult

Source

• Tintinalli