- Discussion:
- consequences of anterior instability include
Bankart lesion,
Hill Sachs lesion, erosion of the
anterior glenoid, loose body formation, and stretching of the
joint capsule;
-
features:
- degree of trauma involved
- distinguish between traumatic dislocations and
recurrent atraumatic instability;
-
types of anterior dislocation:
- degree of instability (3rd deg = should that is manually unstable);
-
associated injuries:
- Radiographic Studies:
-
Apical Oblique View
-
Axillary View
-
Stryker Notch view for picking up a
Hill Sachs;
-
Transscapular View
-
True AP - (35 deg oblique to the body)
-
West Point Axillary View:
- used to determine osseous
bankart defect on anteroinferior glenoid rim;
-
discussion:
- common radiographic changes seen following anterior dislocations, include Hill Sachs lesion, calcification
along the antero-inferior aspect of the glenoid rim (or fracture of the glenoid rim);
- additional findings include fracture, erosion, blunting of the anterior glenoid rim;
- Physical Exam:
- Initial Field Treatment:
- only shoulder injury that cannot be effectively immobilized in simple sling and swathe is the common anterior shoulder dislocation;
- following this injury, the arm is locked in moderate abduction and cannot be brought comfortably against the chest wall;
- anteriorly dislocated shoulder & arm must be spinted in abducted position in which they are found;
- pillow or rolled blanket is used to fill space between arm & chest wall;
- elbow is flexed to right angle and a sling applied to support arm;
- pillow & sling are secured as unit to the chest w/ one or two swathes;
- Reduction Methods:
- Operative Indications:
- soft tissue interposition:
- rotator cuff, capsule, and
biceps tendon may prevent reduction;
- displaced fractures of the
greater tuberosity:
- not uncommon w/ shoulder dislocation, however, this frag usually reduces into acceptable position when shoulder is reduced;
- occass.
greater tuberosity displaces up under acromion process or is pulled posteriorly by the cuff muscles;
- glenoid rim fractures;
- Surgical Treatment
