خلع مفصل الكتف - Shoulder joint dislocation (subtitled)

A shoulder dislocation is an injury in which humeral head pops out of the glenoid. Once the person has had a dislocated shoulder, his joint may become unstable and be prone to repeat dislocations. Associated Injuries. Bankart lesion which is detachment of the anteroinferior labrum from the glenoid. Fractures of the glenoid. Fracture of humeral head, neck, or greater tuberosity. Hill-Sachs lesion. Axillary nerve damage. Rotator cuff tears. Causes. Sports injuries. Accidents, including traffic accidents. Falling on your shoulder or outstretched arm. Seizures such as epilepsy. electric shocks. Types of shoulder dislocation. There are 3 different types of shoulder dislocation. Anterior dislocation — the humeral head is displaced forward, toward the front of the body. This is the most common type of shoulder dislocation, accounting for more than 95% of cases. Posterior dislocation — less common than anterior dislocations. The humeral head is displaced toward the back of the body. Posterior dislocations are the type most likely to be related to seizures and electric shock. Posterior dislocation on anteroposterior xray view can be difficult to identify. Note the lightbulb shape of the rotated humeral head. It’s called Lightbulb sign. Inferior dislocation — the humeral head is displaced downward. This type of shoulder dislocation is the rarest. Symptoms. Severe shoulder pain. Limited motion of the shoulder. Shoulder bruising or abrasions if an impact has caused the injury. A distortion in the contour of the shoulder. An X-ray of affected shoulder joint will show the dislocation and may reveal broken bones or other damage to your shoulder joint. It is important to seek evidence of a non-displaced humeral neck fracture on the radiographs lest this fracture be displaced during attempted closed reduction. Advanced imaging modalities including CT scan and MRI are frequently needed during the course of clinical decision-making for athletes. Closed reduction. For Anterior dislocation, a gentle traction is applied to the affected arm. An assistant applies firm countertraction to the chest using a sheet. The doctor can rotate the shoulder externally to unhinge the dislocated humeral head. Sometimes a gentle push on the humeral head helps. For posterior dislocation: gentle, prolonged traction is applied to the arm with the elbow flexed. While traction applied, the arm is externally rotated. Apply direct pressure on the posterior aspect of the humeral head direction it anteriorly. For Inferior dislocation: apply prolonged axial traction to the abducted arm. Increase the abduction while applying pressure on the humeral head superiorly. A successful reduction is usually indicated by a soft palpable clunk and return of mobility. Because the joint can spontaneously dislocate after successful reduction, do not delay immobilizing the joint using a swath and sling. Typical time periods in a sling range for 3-6 weeks if the patient is under the age of 40. And 1-2 weeks if older than the age of 40. And 6weeks in case of associated fracture. In case of posterior dislocation, immobilize the shoulder in (20°) external rotation and with slight abduction. Radiography should be done after reduction to ensure proper alignment of the joint structures. Painkillers and muscle relaxants are prescribed. During the first 2 days, applying an ice pack to the shoulder 3 times a day for 15 to 20 minutes may reduce swelling and ease pain. We usually recommend four to six weeks of physical therapy as part of a treatment plan. Return to sports or physical activities of daily living after 3-6 months. Several surgeries can be performed to treat dislocated shoulders. Arthroscopic Bankart repair. This surgery is considered for first-time traumatic shoulder dislocation With Bankart lesion confirmed by MRI in athlete younger than 25 years of age. And for recurrent dislocation (more than one dislocation). Hill-Sachs remplissage procedure: The remplissage procedure may be performed as an adjunct to Bankart repair to treat engaging large (more than 25) Hill-Sachs defect. Remplissage is a procedure that insets the posterior shoulder capsule and infraspinatus tendon into the Hill-Sachs defect, converting the intra-articular location of the defect to an extra-articular one. The procedure is carried out by placing one or two suture anchors into the defect. Coracoid transfer called Latarjet procedure, is indicated for chronic bony deficiencies with 25% glenoid deficiency. Or when a surgical repair of the labrum does not prevent the recurrent dislocation. The arm is placed in a sling to rest the shoulder and promote healing. Physical therapy program for three months. return to sport 4-6 months post-surgery