Upper Limb Dislocations

Keith StaffordProfession Teaching Fellow

Dislocation

• Definition : Loss of congruity between the articular surfaces of a joint

• Therefore displacement usually complete

• The head of the humerus becomes completely separated from the glenoid fossa of the scapula

• May be complicated by fracture

History Shoulder dislocations

• May be recurrent, and if so may be trivial history

• Trauma, force/axial loading from falls and motor bike accidents (e.g. tackler in rugby)

• Seizures

Subluxation

• AKA partial dislocation

• Loss of contact of the articulating surfaces is notable but incomplete

• May proceed to complete dislocation

Presentation

• PAIN +++

• Arm guarded in the most comfortable position

• Often a kinking noted to the outer contour of the shoulder

Examination

• Neurovascular examination,including axillary/circumflex nerve

• Wounds or other injuries

• Palpate the outer edge of the acromion

Anterior dislocation

Posterior dislocation

Inferior dislocation/luxio erecta

Reduction

• Reduction is required and needs to be as soon as possible

• Reduction is often reported to be painful and traumatic. Consider analgesia/sedation

• Failure to reduce

Fares technique: reduction of anterior shoulder dislocation

• http://www.youtube.com/watch?v=NXFPWxSTK5c

Other techniques

• Kochers/external rotation

• Stimpsons

• Milch

Treatment/follow up

• Sling

• Analgesia

• Orthopaedic clinic

Elbow dislocations

• Often results from fall onto the outstretched hand

• Often confused with supracondylar fracture

• As always assess for neurovascular compromise

Radiology

Aftercare

• Post reduction radiographs

• Above elbow backslab

• Orthopaedic follow-up

Anterior elbow dislocation

Finger dislocations

Carpal dislocations

Carpal dislocations (2)

References.• Mcrae R and Essler M (2008) Practical fracture treatment. Elsevier.• Gudena, R., K. P. Iyengar, et al. (2011). "Irreducible shoulder dislocation - a word of caution."

Orthopaedics & traumatology, surgery & research 97(4): 451-453• Huang, I. Y., C. M. Chen, et al. (2011). "Management of long-standing mandibular dislocation."

International Journal of Oral & Maxillofacial Surgery 40(8): 810-814• Chechik, O., M. Khashan, et al. (2011). "[Primary anterior shoulder dislocation]." Harefuah

150(2): 117-12• Blaivas, M., S. Adhikari, et al. (2011). "A prospective comparison of procedural sedation and

ultrasound-guided interscalene nerve block for shoulder reduction in the emergency department." Academic Emergency Medicine 18(9): 922-927.

• Longo, U. G., P. E. Huijsmans, et al. (2011). "Video analysis of the mechanisms of shoulder dislocation in four elite rugby players." Journal of Orthopaedic Science 16(4): 389-397.

• Ashton, H. R. and Z. Hassan (2006). "Best evidence topic report. Kocher's or Milch's technique for reduction of anterior shoulder dislocations." Emergency Medicine Journal 23(7): 570-571.

• Baykal, B., S. Sener, et al. (2005). "Scapular manipulation technique for reduction of traumatic anterior shoulder dislocations: experiences of an academic emergency department." Emergency Medicine Journal 22(5): 336-338

• Caudevilla Polo, S., E. Estebanez de Miguel, et al. (2011). "Humerus axial traction with acromial fixation reduction maneuver for anterior shoulder dislocation." Journal of Emergency Medicine 41(3): 282-284

References• Cunningham, N. (2003). "A new drug free technique for reducing anterior shoulder

dislocations." Emergency Medicine (Fremantle, W.A.) 15(5-6): 521-524• Dannenbaum, J., C. A. Krueger, et al. (2012). "A review of reduction techniques for anterior

glenohumeral joint dislocations." Journal of Special Operations Medicine 12(2): 83-92.

• Fernandez-Valencia, J. A., J. Cune, et al. (2009). "The Spaso technique: a prospective study of 34 dislocations." American Journal of Emergency Medicine 27(4): 466-469.

• Harnroongroj, T., J. Wangphanich, et al. (2011). "Efficacy of gentle traction, abduction and external rotation aneuver under sedative-free for reduction of acute anterior shoulder dislocation: retrospective comparative study." Journal of the Medical Association of Thailand 94(12): 1482-1486.

• Hunter, B. and L. Wilbur (2012). "Can intra-articular lidocaine supplant the need for procedural sedation for reduction of acute anterior shoulder dislocation?" Annals of Emergency Medicine 59(6): 513-514.

• Marinelli, M. and L. de Palma (2009). "The external rotation method for reduction of acute anterior shoulder dislocations." Journal of Orthopaedics & Traumatology 10(1): 17-20.

• Sahin, N., A. Ozturk, et al. (2011). "A comparison of the scapular manipulation and Kocher's technique for acute anterior dislocation of the shoulder." Eklem hastaliklari ve cerrahisi = Joint Diseases & Related Surgery 22(1): 28-32.

• Sayegh, F. E., E. I. Kenanidis, et al. (2009). "Reduction of acute anterior dislocations: a prospective randomized study comparing a new technique with the Hippocratic and Kocher methods." Journal of Bone & Joint Surgery - American Volume 91(12): 2775-2782.

• Tudor, B. C., R. E. Norris, et al. (2010). "Anterior shoulder dislocation: the scapular manipulation technique." Academic Emergency Medicine 17(6): e40

• Ufberg, J. W., G. M. Vilke, et al. (2004). "Anterior shoulder dislocations: beyond traction-countertraction." Journal of Emergency Medicine 27(3): 301-306