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 100-160 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