Shoulder dislocation
Swelling
Head palpable
position of extremity
Anterior test
Duga's test
Ruler test
Callaway test
Neurological impairment
Instability
Fulcrum test
apprehension
Jobe's relocation test
Jerk test
Drawer test
Sulcus test
Investigations
AP view
Scapular view
lateral view
information about direction of dislocation , fracture , blocks for relocation
Stryker notch view - for humeral head defects
West point axillary view - shows notch defects
CT scan - shows detailed anatomy
MRI - associated rotator cuff tear and labral tears
Arhtroscopy - invasive
difficult atraumatic structural and muscle pattern in non structural cases
EMG - atraumatic complex instability situation
Treatment
Urgent reduction
1. Stimson method - prone , downward traction
2. Kocher method - Redislocation rates higher
3. Spaso technique - supine and ER and long traction
4. Hippocratic
5. Traction and countertraction
Open reduction for old dislocation
Intelligent neglect - for old dislocation with good functional range
Post reduction check congruency , stability , immobilize
Later assess apprehension , cuff muscles
Complication
Recurrence - as high as 90 % in < 20 years
in external rotation immobilization - low recurrence rate
Head palpable
position of extremity
Anterior test
Duga's test
Ruler test
Callaway test
Neurological impairment
Instability
Fulcrum test
apprehension
Jobe's relocation test
Jerk test
Drawer test
Sulcus test
Investigations
AP view
Scapular view
lateral view
information about direction of dislocation , fracture , blocks for relocation
Stryker notch view - for humeral head defects
West point axillary view - shows notch defects
CT scan - shows detailed anatomy
MRI - associated rotator cuff tear and labral tears
Arhtroscopy - invasive
difficult atraumatic structural and muscle pattern in non structural cases
EMG - atraumatic complex instability situation
Treatment
Urgent reduction
1. Stimson method - prone , downward traction
2. Kocher method - Redislocation rates higher
3. Spaso technique - supine and ER and long traction
4. Hippocratic
5. Traction and countertraction
Open reduction for old dislocation
Intelligent neglect - for old dislocation with good functional range
Post reduction check congruency , stability , immobilize
Later assess apprehension , cuff muscles
Complication
Recurrence - as high as 90 % in < 20 years
in external rotation immobilization - low recurrence rate
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