Which of the following is true about anterior shoulder dislocation
Ans. is 'a' i.e., It is most common type of shoulder dislocation Anterior dislocation of shouldero Anterior dislocation of the shoulder is the most common type of shoulder dislocation. Head of the humerus comes out of the glenoid cavity and lies anteriorly. Anterior dislocation of shoulder could be:-1) Preglenoid It is the most common type of anterior dislocation and head lies in front of glenoid.2) Subcoracoid The head lies below the coracoid process.3) Subclavicular (infraclavicular)The head lies below the clavicle.4) Intrathoracic It is very rare.o Mechanism of Injury Two types of injury may lead to anterior dislocation:i) Indirect force (most common) Abduction, external rotation and extension force due to fall on outstretched hands or during throwing.ii) Direct force (less common) - Direct blow on shoulder from posterior or posterior lateral such as a fall on elbow directed backward and outward.Clinical features of anterior dislocationo Severe pain and inability to move shoulder.o Patient keeps his arm by the side of the body in a position of abduction and external rotation.o Adduction and internal rotations are restricted.o Shoulder is "squared of' i.e., normal round contour of shoulder is lost and it becomes flato Humeral head is palpable anteriorly in subcoracoid region, beneath the clavicleo There is anterior fullness in shoulder.o Dugas test: It is not possible for the patient to bring the elbow close to the body & put the hand on his opposite shoulder.o Callway's test: In dislocation vertical circumference of axilla is increased compared to the normal sideo Hamilton ruler test: Because of flattening of shoulder, it is possible to place a ruler on the lateral side of arm and it touches acromian & lateral condyle of humerus simultaneously (in normal it would not due to shoulder contour)o Bryant's test: Anterior axillary fold is at lower levelo Regiment badage test: Area of anesthesia around the deltoid due to injury to the axillary nerve.Complications of anterior dislocationo Anterior dislocation of shoulder may have following complications.i) Injury to the axillary (circumflex) nerve is the most common complication (5-30%).ii) Occasionally other branches of brachial plexus are damaged especially the posterior cord.iii) Occasionally axillary artery may be damaged especially if the vessel is athromatous or it may damage during attempted late reduction.iv) Associated fractures like greater tuberosity.v) Recurrent dislocation.o The most common complication of anterior dislocation of shoulder is axillary (circumflex) nerve injury. There is consequent paralysis of the deltoid muscle, with a small area of anaesthesia at the lateral aspect of the upper arm.Treatment of anterior dislocationo Anterior dislocation of shoulder is an emergency and has to be immediately reduced. Reduction should be gentle and should be done preferably under general anaesthesia. There are various methods of reduction:-1) Kocher's maneuver# The most commonly used method is the Kocher's method# The various steps of this method of reduction are (remember TEAM) T- Traction (along the line of humerus) E- External (lateral) rotation of arm A- Adduction of arm M- Medial (internal) rotation of arm2) Stimson's gravity method Patient is left prone with the arm hanging over the side of bed. Thus weight of limb helps in reduction.3) Hippocrates maneuver Reduction is done by axial traction in semiabducted arm with countertraction is given by placing the foot in axilla.o After the reduction, the arm should be immoblized for 3 weeks by chest arm strapping.
It is most common type of shoulder dislocation
It is most commonly subclavicular
Patient keeps his arm in saluting position
Injury to brachial plexus may occur
Dislocation of Shoulder