glenohumeral dislocation: class, complications and management august 21, 2003 emergency xr rounds...
TRANSCRIPT
Glenohumeral Dislocation: Class, Complications and Management
August 21, 2003
Emergency XR Rounds
Simon Pulfrey (with much gleaned from Dave Dyck)
Complications of anterior glenohumeral dislocation and
reduction
• Neurovascular – neuropraxic and recover in days-weeks
• Fractures – Hill-Sachs – 11-50% of ant dislocations. May
be higher if consider minor compression fractures
– Bankart – ant glenoid rim #. 5% of cases.– Avulsion # of greater tuberosity in 10-15%.
Complications of anterior glenohumeral dislocation and
reduction
• Rotator cuff injury – 10-15% will have tear. Higher incidence in those >40yrs.
• Capsulolabral avulsions in those of younger years
Luxatio Erecta
• 0.5%• Usually axial load on abducted arm or
indirect trauma• Presents with 100-160 deg of abduction• Humeral shafts lies parallel to spine of
scapula (infglenoid lies against chest wall)• Usually need ortho help• Wary buttonhole problem
Posterior Dislocation
• Rare. 2%.
• Commonly missed (50%!)
• Seizures, fall on flexed and adducted arm, direct blow
• Deceptively normal-appearing AP XR
• Increased importance of clinical exam
Clinical Findings:
• Arm adducted and internally rotated
• The anterior shoulder is flat and the posterior aspect full
• Prominent coracoid
• The patient won’t allow abduction or external rotation