Shoulder Dislocation
Nguyen Phuoc Thanh . MD
Definition
Glenohumeral instability is the inability
to maintain the humeral head in the
glenoid fossa
Reasons for instability
Shallow glenoid
Extraordinary ROM
Vulnerability of upper limb to injury
Underlying conditions eg.
ligament laxity
Directions of instability
Anterior
◦ 97% of recurrent dislocations
subcoracoid - abd, extension and external
rotation
subglenoid
subclavicular
intrathoracic
Posterior
◦ 3% of recurrent
◦ Seizures, shock, fall on flexed + adducted
arm
subacromial
subglenoid
subspinous
Inferior
Superior
Bilateral
Dislocation of the Shoulder
Mostly Anterior > 95 % of dislocations
Posterior Dislocation occurs < 5 %
True Inferior dislocation (luxatio erecta) occurs <
1%
Habitual - Non traumatic dislocation may
present as Multi directional dislocation due
to generalized ligamentous laxity and is
Painless
Mechanism
Usually Indirect fall on Abducted and
extended shoulder
May be Direct when there is a blow
on the shoulder from behind
Pathoanatomy of dislocation
Stretching/ tearing of capsule
Avulsion of glenohumeral ligaments
usually off the glenoid
Labral injury
◦ Bankart lesion
Impression fracture
◦ Hill-Sach lesion
Rotator cuff tear
Clinical Picture
Pain
Holds injured limb with
other hand close to
trunk
The shoulder is
abducted and the elbow
is kept flexed
Clinical Picture
Loss of the normal
contour of the shoulder -
appears as a step
Anterior bulge of head
of humerus may be
visible or palpable
Empty glenoid socket
Anterior Shoulder dislocation
Usually also inferior
Radiograph
AP view
https://www.startradiology.com/internships/general-surgery/shoulder/x-shoulder/
Radiograph Y view
https://www.startradiology.com/internships/general-surgery/shoulder/x-shoulder/
Radiograph
https://www.startradiology.com/internships/general-surgery/shoulder/x-shoulder/
Anterior Dislocation of Shoulder
Management
Emergency
Should be reduced in < 24 hours or
else AVN of head of humerus
Immobilised strapped to the trunk for
3-4 weeks and rested in a collar and
cuff
Management
Reduction
◦ Closed
◦ Open
Maneouvers
Traction-countertraction method
Hippocrates method
Stimpson’s technique
Kocher’s technique
Etc..
Traction-countertraction
Alkaduhimi, H et al. “A systematic and technical guide on how to reduce a shoulder dislocation.” Turkish journal of emergency
medicine vol. 16,4 155-168. 18 Nov. 2016, doi:10.1016/j.tjem.2016.09.008
Hippocrates Method
Alkaduhimi, H et al. “A systematic and technical guide on how to reduce a shoulder dislocation.” Turkish journal of emergency
medicine vol. 16,4 155-168. 18 Nov. 2016, doi:10.1016/j.tjem.2016.09.008
Chair method Manes’s method
Alkaduhimi, H et al. “A systematic and technical guide on how to reduce a shoulder dislocation.” Turkish journal of emergency
medicine vol. 16,4 155-168. 18 Nov. 2016, doi:10.1016/j.tjem.2016.09.008
Stimpson’s technique
Alkaduhimi, H et al. “A systematic and technical guide on how to reduce a shoulder dislocation.” Turkish journal of emergency
medicine vol. 16,4 155-168. 18 Nov. 2016, doi:10.1016/j.tjem.2016.09.008
Scapular manipulation
Alkaduhimi, H et al. “A systematic and technical guide on how to reduce a shoulder dislocation.” Turkish journal of emergency
medicine vol. 16,4 155-168. 18 Nov. 2016, doi:10.1016/j.tjem.2016.09.008
Spaso technique
Kocher’s Technique
VanBaak K., Mayer S.W., Kraeutler M.J., Khodaee M. (2020) Glenohumeral Joint. In: Khodaee M., Waterbrook A., Gammons
M. (eds) Sports-related Fractures, Dislocations and Trauma. Springer, Cham. https://doi.org/10.1007/978-3-030-36790-9_14
Cunningham
technique
Alkaduhimi, H et al. “A systematic and technical guide on how to reduce a shoulder dislocation.” Turkish journal of emergency
medicine vol. 16,4 155-168. 18 Nov. 2016, doi:10.1016/j.tjem.2016.09.008
Step 1
Step 2
Step 3
https://dislocation.com.au/cunningham
Milch maneuver
Zero position
Step 1
Step 2
FARES technique
Boss-Holzach-Matter method
Immobility after reduction
Complications of anterior Shoulder
Dislocation : Early
Nerve –
Axillary Artery
– Axillary
Ligaments
Bone -
Associated
fracture
◦ Neck of
humerus
◦ Greater or
The Kocher maneuver specifically has been
reported to cause a rupture of the pectoral
muscle or a fracture of the humerus.
While the Hippocratic method could result in
neuropraxia of the brachial nerve.
Alkaduhimi, H et al. “A systematic comparison of the closed shoulder reduction techniques.” Archives of orthopaedic
and trauma surgeryvol. 137,5 (2017): 589-599. doi:10.1007/s00402-017-2648-4
Alkaduhimi, H et al. “A systematic comparison of the closed shoulder reduction techniques.” Archives of orthopaedic
and trauma surgeryvol. 137,5 (2017): 589-599. doi:10.1007/s00402-017-2648-4
Alkaduhimi, H et al. “A systematic comparison of the closed shoulder reduction techniques.” Archives of orthopaedic
and trauma surgeryvol. 137,5 (2017): 589-599. doi:10.1007/s00402-017-2648-4
Axillary nerve injury
Bankart lesion – Soft tissue
Bankart lesion - Bony
https://www.startradiology.com/internships/general-surgery/shoulder/x-shoulder/
Hill-Sachs lesion
https://www.startradiology.com/internships/general-surgery/shoulder/x-shoulder/
Complications of anterior shoulder
Dislocation : Late
Avascular necrosis of the head of
the Humerus (high risk with delayed
reduction)
Heterotopic calcification ( used
to be called Myositis Ossificans )
Recurrent dislocation
Posterior dislocation
5-10% of shoulder dislocations
Shoulder is in adduction flexion and
internal rotation
Mechanism
Indirect
◦ Electric shock
◦ Seizure episode
Direct
◦ Force on the anterior shoulder
Shoulder AP view
Scapular Y-view
Closed Reduction
Traction to adduct arm in the line of
deformity
Gentle lifting of humeral head into the
glenoid fossa
Operative treatment
Failed closed
Displaced fracture
Recurrence
Large defect
◦ Reverse Hill Sachs
Reverse Hill-Sachs
Complications
Neurological
◦ Axillary
◦ Nerve to infraspinatus
Vascular
Fractures
Recurrence
Inferior Dislocation
Luxatio erecta
Mechanism
Hyperabduction force
Radiograph
Reduction
Operative
Buttonholing
Complications
High
◦ Vascular
◦ Neurological
◦ Ligaments
◦ Fractures
Evaluation of recurrent
atraumatic instability
History
◦ Trauma?
◦ Sports
◦ Throwing or overhead activities
◦ Voluntary subluxation
◦ “Clunk” or knock
◦ Fear
◦ Hx of dislocations and energy associated
Physical
◦ Demonstrate dislocation/subluxation ?
◦ Laxity tests
◦ Stability tests
Generalised ligament laxity
Management
Conservative
◦ Acute episode
◦ Immobilisation
◦ Physiotherapy – Strengthening exercises
Operative reconstruction
◦ Soft-tissue reconstruction
◦ Bony reconstruction
Case report
