Shoulder dislocation
Background
Left shoulder and acromioclavicular joints with ligaments.
Shoulder anatomy, anterior.
Shoulder anatomy, posterior.
- Humerus separates from the scapula at the glenohumeral joint
- Partial dislocation of the shoulder is referred to as subluxation
- Dislocation duration inversely correlated with likelihood of successful ED reduction
Shoulder dislocation types
Differential Diagnosis
Shoulder and Upper Arm Diagnoses
Traumatic/Acute:
- 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
- Axillary artery thrombosis
- Thoracic outlet syndrome
- Subclavian steal syndrome
- Pancoast tumor
- Myocardial infarction
- Pneumonia
- Pulmonary embolism
Evaluation
Workup
- Plain film X-ray
- Include anteroposterior, scapular Y, and axillary views
- Associated fractures include:
- Hills-Sachs: cortical depression in the humeral head
- Bankart: glenoid labrum disruption with bony avulsion
- Humeral greater tuberosity fracture
- Consider joint ultrasound
Diagnosis
Anterior shoulder dislocation on Y-view
Anterior shoulder dislocation with fracture
Management
Reduction
- Do not attempt to reduce chronic dislocations (>4 weeks) in ED due to risk of arterial injury - these require reduction in the OR
- Lower complications, equal pain control, and shorter ED stay with intra-articular lidocaine vs. procedural sedation[1]
- 20 mL of 1% lidocaine intra-articular injection
- See individual types for specific techniques:
Disposition
- Uncomplicated dislocation can be discharged after reduction
Prognosis
- Recurrence rate around 27% if older than 30 years and 72% is younger than 23 years[2]
See Also
External Links
Video
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References
- Intra-articular lignocaine versus intravenous analgesia with or without sedation for manual reduction of acute anterior shoulder dislocation in adults (Review) Cochrane Database Syst Rev. 2011 Apr 13;(4):CD004919 full text
- Watson S, Allen B, Grant JA. A Clinical Review of Return-to-Play Considerations After Anterior Shoulder Dislocation. Sports Health. 2016; 8(4):336-341.
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