Glenohumeral Dislocation: Class, Complications and Management

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Glenohumeral Dislocation Class, Complications
and Management

• August 21, 2003
• Emergency XR Rounds
• Simon Pulfrey (with much gleaned from Dave Dyck)

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Normal
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Diagnostic Strategies

• 1- True AP

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2. Axillary
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Transcapular or Y View
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Post reduction
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Hill-Sachs
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Post reduction
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Bankhart
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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.

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Complications of anterior glenohumeral
dislocation and reduction

• Rotator cuff injury 10-15 will have tear.
  Higher incidence in those gt40yrs.
• Capsulolabral avulsions in those of younger years

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Infraglenoid Dislocation Hill-Sachs Fracture
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Luxatio Erecta
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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

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

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Clinical Findings

• Arm adducted and internally rotated
• The anterior shoulder is flat and the posterior
  aspect full
• Prominent coracoid
• The patient wont allow abduction or external
  rotation

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Rim sign ant glenoid rim and articular surface
of hh increased (usugt6mm)
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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