Case 5 Recurrent Shoulder Dislocation


Case 5
Recurrent Shoulder Dislocation

What is your Problem ?           When and how it occurred ?               Dominance of hand ?             

How many times did it occur ?           other joints have same problem ?

Ask above questions though only two questions are allowed during smooth physical examination , examiners wont mind here .

Look
Alignment of Upper Extremity – Normal
Attitude – not particular
Both shoulder look symmetrical
Overlying skin – Normal / with or without muscles wasting on anterior / lateral / posterior and medial side

(       Not forget to lift arm and see axilla )

Feel
Temperature
Tenderness – Superficially and Deep
Movement of Shoulder
            Active
                        Flexion / Extension
                        Abduction / Adduction
                        External Rotation / Internal Rotation
 Lack of motion requires passive ROM testing .
Ligamentous Instability – Screening test , thumb and MCP Hyperextension more than 90 degrees

Signs of Instabilities
Sitting –          Apprehensive Sign
                        Anterior Drawer test
                        Sulcus Test
Lying -            Jobe’s Relocation test
                        Laxity Test – Load and Shift test both anterior and posterior
                        Jerk Test
                        Circumduction
Findings for
Anterior Dislocation
            Apprehension and Relocation sign
            Anterior Drawer test
            Fulcrum
            Load and Shift
Posterior Dislocation
            Posterior Drawer
            Load and Shift
            Jerk
            Circumduction
Multidirectional Instability
            Suclus Sign ,
            Beighton Score
           
           


                       
Neurovascular Examination
Pulsation – Radial / Ulnar
Sensation – Radial / Median / Ulnar              

Discussion 
Investigation 

Management 

Different Surgery names for rotator cuff tear and shoulder instability  - important .




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