Anterior Shoulder Dislocation

Last Updated on July 1, 2022

Introduction

A common type of dislocation seen in ED, especially anterior shoulder dislocation

Types:
• Anterior dislocation (95%)
• Posterior dislocation (≈4%)
• Inferior dislocation

Clinical Features

Mechanism of injury

• Patient had a fall due to seizure / accident

Presentation

• Patient complained of extreme pain over affected shoulder

Physical examination

Features of anterior dislocation
• Affected shoulder appears ‘squared off‘
• Fullness of anterior shoulder

Examine for potential complications
• Axillary nerve sensation
• Radial nerve function
• Pulses at wrist

Complications

• Axillary nerve injury
• Radial nerve injury (rare)
• Brachial plexus injury (rare)
• Axillary artery transection (rare)
• Bankart lesion
• Recurrence

Investigation

X-rays

• Shoulder X-ray: AP view and scapular Y-view of affected side, to look for type of dislocation and presence of fracture PRIOR to CMR

=====
Other findings:
• Hill Sachs lesion

CT scan

• Done in fracture-dislocation, to assess fracture configuration as pre-op planning

Management of anterior shoulder dislocation — CMR Under PSA

Prior to procedure

• Consent
• Examination and documentation of axillary nerve, radial nerve and pulses at wrist
• Preparation for procedural sedation analgesia

Methods of reduction

• Kocher’s manoeuvre [Video 1] [Video 2] [Video 3]
• Cooper Milch technique
• Stimson’s technique
• Countertraction technique
• Hippocratic manoeuvre
• Cunnigham method
• Spaso technique

Post-procedure

• Recheck neurovascular status of affected upper limb
• Immobilization – Apply collar and cuff and strappings [video 1] [video 2]
• Check X-ray post CMR
• Documentation

Discharge plan:
• Referral letter to Orthopaedic Clinic in 2 weeks with XOA of affected shoulder (AP and Y view)
• Analgesics e.g. T Paracetamol 1 g QID + Cap Tramal 50 mg TDS
• Advise patient to be compliant to the collar and cuff & strapping
• Medical Certificate (MC)

Notes

💡 ED team should refer ortho team if failed to reduce dislocation after 1 – 2 attempts

Related Posts

• Posterior shoulder dislocation [open]
• Procedural sedation [open]

Anterior Shoulder Dislocation VS Posterior Shoulder Dislocation

Q&A

Further Reading

• FB Dr Alzamani