Skill Checkup: Reduction of Shoulder Dislocation

Richard H. Sinert, DO

Disclosures

January 02, 2019

For subcoracoid and subglenoid dislocations, which account for 99% of anterior shoulder dislocations, joint reduction by the ED physician is typically indicated. Subclavicular or intrathoracic dislocations, which are caused by large forces, are not easily corrected and should be referred to an orthopedic surgeon.

Anterior dislocations (in which the humeral head is displaced anteriorly in relation to the glenoid), account for as many as 95%-98% of shoulder dislocations. The reason is that the muscular and ligamentous support anterior to the humeral head is much less robust than the substantial muscular and bony support afforded posteriorly by the rotator cuff and scapula. Posterior shoulder dislocations are considerably less common, accounting for no more than 4% of all shoulder dislocations. Perhaps for this reason, many posterior shoulder dislocations are initially missed by treating physicians, and diagnosis is delayed in nearly all cases.

Before any attempts at reduction, the provider should perform a neurovascular examination and assess the probability of a fracture, considering the mechanism of injury and the physical characteristics of the patient. The axillary nerve is the most commonly injured nerve in shoulder dislocations and can be evaluated by testing for sensation in the lateral upper arm and by palpating for contraction of the deltoid muscle while the patient abducts against resistance. The clinician should also look for possible damage to other branches of the brachial plexus.

For an uncomplicated posterior shoulder dislocation that is diagnosed within 6 weeks of injury, reduction in the ED is generally appropriate. A small humeral head defect is not a contraindication for attempting a closed reduction in the ED. A fracture-dislocation with a nondisplaced lesser tuberosity fracture may be treated with a closed reduction.

Read here for more information on reduction of shoulder dislocation.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....