Makindo Medical Notes.com

Always examine and document axillary nerve function. The axillary nerve runs close to the shoulder joint and can be injured during dislocation, leading to numbness in the deltoid area or weakness in the shoulder.

About

• The shoulder is the most commonly dislocated major joint.
• Usually the head of the humerus is displaced Inferiorly or anteriorly
• Posterior dislocations are uncommon but associated with seizures

Types

Clinical

• The arm is classically held internally rotated and adducted
• It is painful and there is loss of the normal rounded appearance of the shoulder
• Inability to Move the Shoulder: Limited or no range of motion.
• Swelling and Bruising: Around the shoulder joint.
• Numbness or Weakness: arm or hand due to nerve compression or damage.
• Spasm of Shoulder Muscles. They contract trying to protect the joint.

Complications

• Axillary nerve damage is possible as it lies close to the surgical neck of the humerus and nerve function should be carefully documented prior to manipulation - check sensation over the "shoulder badge" area

Investigations

• An AP film or a transcapular Y view film is best

Management

• Immobilise with broad arm sling. Reduction may need simple sedation or even a General anaesthetic
• Closed reduction: Modified Kocher's technique and recheck axillary nerve - elbow is flexed and the forearm rotated outwards. The elbow is then swung medially across the trunk levering the head of the humerus back into place. There is a Hippocratic method using the ball of the heel in the axilla and traction and adduction.
• Open Reduction: If the dislocation cannot be reduced manually or if there are associated fractures, surgery may be required.
• After reduction, the shoulder is usually immobilized in a sling or a shoulder immobilizer for a period, typically 1 to 3 weeks, depending on the injury and patient's age.
• Rehabilitation is critical to restore range of motion, strength, and stability to the shoulder. Exercises often start with gentle passive movements and gradually progress to active strengthening exercises.
• Surgery may be necessary for recurrent dislocations, large labral tears, significant fractures, or when the initial dislocation is associated with severe soft tissue damage.