subluxation and dislocation of ac joint

8/6/2019 Subluxation and Dislocation of Ac Joint

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By: David Gan


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` Definition

` Causes and Mechanism

` X-ray

` Classification

`

Clinical Features` Special Test

` Complications

` Treatments

` References

` Other Useful Links


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DislocationSubluxation

` Joint surface completely

displace.

` No longer in contact.

` Lesser degree of

displacement.

` Articular surface stillpartly apposed.

Adapted: Solomon, Warwick and Nayagam, 2005, pp. 280


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` Anterior Dislocation: Arm

Abducted, Extended &

Externally Rotated.

` Posterior Dislocation: Armabducted, Flexed & Internally

Rotated.

` Neurological Conditions ie.

Stroke.` Recurrent

` Habitual (voluntary)

Weak muscles insupporting the GH joint

Adapted: Shankman, 2004, pp.397

Ligaments & jointmargins aredamaged.Repeated Dislocation.

Knack of dislocating the jointby voluntary musclecontraction.


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Major Associated Injuries

Bankart lesion Hill-Sachs lesion.

Adapted: Solomon, Warwick and Nayagam, 2005, pp. 280


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` Definition :

`

Resulting from :

Causes and Mechanism

Traumatic anteriordislocation of the

shoulder.

An avulsion of the

capsule & glenoid

labrum off the

anterior rim of theglenoid.


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` Definition :

` Resulting from :

Causes and Mechanism

Compression or

impaction fracture of

posterior aspect of

humeral head.

Anterior shoulder

instability.

Forceful impact of the

humeral head against theanteroinferior glenoid rim

when the shoulder is

dislocated anteriorly.


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Posterior Dislocation

In AP projection, humeral

head looks somewhat

globular because it is

medially rotated. Lateral

film is essential which I

cant find on internet.

Large lucencies in the

humeral head and

glenoid (arrow),

subluxation of theglenohumeral joint and

small calcifications in

the soft tissues (thin

arrow).

Anterior Dislocation

Overlapping shadows

of humeral head and

glenoid fossa,

humeral head usually

lying below medial

socket.


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` Rockwood divided shoulder subluxation anddislocation into 4 categories:

Category Description

I No history of traumatic dislocation of subluxation

II A history of traumatic dislocation subluxation

III a. Non-traumatic voluntary subluxation, accompanied by

psychological barriers

III b. Non-traumatic voluntary subluxation is not associatedwith mental disorders

IV Non-voluntary subluxation

Adapted: Knowledge of disease, 2010

For further details please refer to:

http://www.eorif.com/Shoulderarm/ShoulderDislocation.html


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` Pain is severe.

` Supports arm with opposite hand.

` Loath to permit any kind of examination

` Lateral outline of shoulder is flattened

` Small bulge may be seen and felt just

below clavicle.

Arm must always be examined for nerve and vessel

injury.

Clinical Features


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Clinical Features


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` Diagnosis frequently missed *in AP X-ray,

humeral head seems to be in contact with

glenoid.

`Arm held on medial rotation and is locked

in that position.

Clinical Features


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` Anterior dislocation in vast majority of cases but

occasionally it is posterior dislocation.

` Often by time patient is examined, the head is

back in the socket.` Recurrent Anterior Dislocation: C/o shoulder slips

out when the arm is lifted into abduction and

lateral rotation. *Apprehension test +ve if shoulder

is passively manipulated into abduction, extensionand lateral rotation. tense up and resist further

movement.

Clinical Features


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`Anterior Apprehension Test

` Posterior Apprehension Test

` Jerk Test

`

Clunk Test


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` Rotator cuff tear

Often torn, particularly in older people.

` Nerve injury Axillary nerve Unable to contract deltoid, small patch of

anaesthesia over muscle, lesion usually neurapraxia.

Posterior cord of brachial plexus, median nerve ormusculocutaneous nerve may be injured.

` Vascular injury Axillary artery may be damaged Signs of ischemia.

` Fracture-dislocation Associated fractures of proximal humerus.

` Recurrent dislocation If glenoid labrum damaged or detached.


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` Dislocation must be reduce asap; usually with

general anaesthetic and sometimes muscle

relaxant.

` Joint is rest/immobilized until soft-tissue healingoccurs (3-4 weeks).

` All positions that may reproduce mechanism of

dislocation are avoided.

` Follow by a course of physiotherapy.` If ligaments torn Repair (surgery).

Treatment


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` Pain & Swelling : Ice packs, eletrical stimulationand other physical agent.

` General conditioning program of strength, flexibilityand endurance activities. *Avoid certain movementthat aggravates dislocation.

` Strengthening Isometric exercise.

` Scapular motion and stabilization exercise (avoidpain and harmful glenohumeral joint position).

` Life-style modification voluntary dislocation.

Treatment


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` ROM exercises after immobilizationCodmans pendulum exercise, active assisted stretching for

flexion and cable pulleys.

` Strengthening of rotator cuff, anterior shoulder

muscles and scapular stabilizers. 2:1ratio of motion between scapular and glenohumeral joint must

be address (2 glenohumeral flexion after 30 shoulder motion

rotate scapular upward 1)

` Combination of abduction and external rotationare avoided (3 month after remove sling)

anterior dislocation.

Treatment


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` Criteria established by Wilk:

Full, non painful ROM

No palpable tenderness

Continued progression of shoulder strength

` Close Kinematic Chain activities Enchanceproprioception & promote dynamic joint stability.

` Initiate isotonic resistance exercise

Accommodate limitations of motion, pain, provocative position

` Local muscle endurance activities Upper bodyergometer, stepper or walking on treatmill.

Treatment


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Treatment

Codmanspendulumexercise

Active assistedstretching forflexion

Cable pulleys


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Treatment

Strengtheningof Rotator cuffmuscles

Strengtheningof anteriorshouldermuscles

StrengtheningofScapularS

tabilizers


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Plyoball Close-chain proprioceptive exercises

Treatment


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Treatment


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Treatment

Endurance Exerciseusing BodyErgometer


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` Knowledge of Disease (2010) Shoulder dislocationclassification.Available at:http://www.sicheng.net/diseased-reprinted-shoulder-dislocation-classification-2919.html (Accessed: 8

January 2011).` Shankman, G.A. (2004) Fundamental orthopedic

management for physical therapist assistant. 2nd

edn. Missouri: Mosby.

`

Solomon, L., Warwick, D.J. and Nayagam, S. (2005)Apleys concise system of orthopaedics andfractures. 3rd edn. London: Hodder Arnold.


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` Shoulder Dislocation http://www.eorif.com/Shoulderarm/ShoulderDislocation.ht

ml

` Scapular Exercises http://www.exercisebiology.com/index.php/site/articles/the

_best_scapular_muscle_exercises_to_prevent_treat_sho

ulder_pain/

subluxation and dislocation of ac joint

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