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9.05 Shoulder dislocation


Presentation

The patient was holding his shoulder abducted horizontally to the side when a blow knocked the humeral head anteriorly. He arrives holding the shoulder abducted ten degrees from his side, unable to move it without increasing the pain. The delto-pectoral groove is now a bulge (caused by the dislocated head of the hymerus) and the acromion is prominent laterally, with a depression below (where the head of the humerus sits on the undislocated shoulder).

What to to:

What not to do:

Discussion

Your strategy is to relocate the shoulder with minimal damage to the joint capsule and anterior labrum of the glenoid fossa, hoping the patient does not become a chronic dislocator with an unstable shoulder. Chronic dislocators are easier to reduce, and come less often to the ED, because they learn how to relocate their own shoulders.

Posterior dislocations are caused by internal rotation of the shoulder, as during a seizure, and are more subtle to diagnose. Subglenoid dislocation or luxatio erecta is rare and unmistakable, with the arm raised and abducted.


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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
Jon Handler, MD
Michael Gillam, MD