Glenohumeral Dislocation: Class, Complications and Management August 21, 2003 Emergency XR Rounds Simon Pulfrey (with much gleaned from Dave Dyck)

Normal

Diagnostic Strategies 1- True AP

2. Axillary

Transcapular or “Y” View

Post reduction:

Hill-Sachs

Post reduction

Bankhart

Complications of anterior glenohumeral dislocation and reduction Neurovascular – neuropraxic and recover in days-weeks Fractures –Hill-Sachs – 11-50% of ant dislocations. May be higher if consider minor compression fractures –Bankart – ant glenoid rim #. 5% of cases. –Avulsion # of greater tuberosity in 10-15%.

Complications of anterior glenohumeral dislocation and reduction Rotator cuff injury – 10-15% will have tear. Higher incidence in those >40yrs. Capsulolabral avulsions in those of younger years

Infraglenoid Dislocation + Hill-Sachs Fracture

Luxatio Erecta:

Luxatio Erecta 0.5% Usually axial load on abducted arm or indirect trauma Presents with deg of abduction Humeral shafts lies parallel to spine of scapula (infglenoid lies against chest wall) Usually need ortho help Wary buttonhole problem

Posterior Dislocation: -trough sign. Reverse Hill-Sach# on ante-medial hh. -Lightbulb/drum stick

Posterior Dislocation Rare. 2%. Commonly missed (50%!) Seizures, fall on flexed and adducted arm, direct blow Deceptively normal-appearing AP XR Increased importance of clinical exam

Clinical Findings: Arm adducted and internally rotated The anterior shoulder is flat and the posterior aspect full Prominent coracoid The patient won’t allow abduction or external rotation

Rim sign : ant glenoid rim and articular surface of hh increased (usu>6mm)

Summary Reduce ASAP Wary neurovascular status, fractures & rotator cuff injuries Consider necessity of pre & post reduction films on an individual basis Know well three methods of reduction Suspect posterior dislocations in appropriate pts