Work Up for Shoulder Dislocation

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- 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