MANUAL MINORS
A shoulder dislocation occurs when the humeral head is displaced from the glenoid cavity of the scapula, causing acute pain and loss of mobility. It is the most common large joint dislocation, accounting for 50% of all joint dislocations.
The shoulder’s high mobility makes it inherently unstable, predisposing it to such injuries, especially during sports or accidents. Dislocations can be anterior (most common), posterior, or inferior, depending on the direction of the displacement.
Diagnosis
The diagnosis is based on a history of trauma or sudden movement, with symptoms of intense pain, visible deformity (the shoulder appears “sunken” in anterior dislocations), and inability to move the arm.
Clinical evaluation reveals a loss of the shoulder’s rounded contour. Anteroposterior and axial X-rays confirm the dislocation and help identify its direction and any associated fractures, such as a Bankart fracture or Hill-Sachs lesion, which are common in anterior dislocations.
Differential Diagnosis
Pathology | Characteristics |
|---|---|
Humeral head fracture | Similar pain and deformity, but without joint dislocation |
Rotator cuff tear | Shoulder pain and weakness without visible deformity |
Acromioclavicular dislocation | Deformity at the top of the shoulder, without humeral head displacement |
Bicipital tendinitis | Anterior shoulder pain without deformity or complete loss of mobility |
Shoulder contusion | Pain after trauma, with preserved mobility and no bone displacement |
Emergency Management
Initial emergency management involves immediate reduction of the dislocation to restore anatomical alignment and relieve pain. Reduction can be performed using manual techniques, such as Kocher or Hippocrates methods, under sedation or local anaesthesia.
It is crucial to assess neurovascular status (particularly the axillary nerve) before and after reduction. Following successful reduction, X-rays confirm proper alignment, and the shoulder is immobilised with a sling or splint for 2 to 4 weeks to allow healing of soft tissues.
Definitive Treatment
Definitive treatment depends on the stability of the shoulder after reduction and the presence of associated injuries. In young patients with recurrent dislocations, or in cases with significant injuries (e.g., Bankart fracture or Hill-Sachs lesion), surgery may be necessary to stabilise the joint through labrum or capsular repair.
In older patients or those without recurrence, conservative treatment with immobilisation followed by physiotherapy is effective in restoring strength and range of motion. Rehabilitation is essential to prevent chronic instability or recurrent dislocations.
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