Dislocation of the shoulder joint

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Dislocation of the shoulder joint is most often caused by indirect force during an impact on the shoulder with an abducted and externally rotated arm, i.e. the greater tuberosity rests on the acromion and the head luxates downward and forward.

Classification according to head dislocation[edit | edit source]

90% front (extra-, sub-, intracoracoid to subclavicular)^[1]
10% posterior (subacromial or subspinal) and inferior (axillary, luxatio erecta)
sometimes simultaneous fractures (tuberculum majus, collum humeri)

Bankart's lesion - break-off of the front edge of the labrum glenoidale with the sheath and ligaments. glenohumeral
'Hill–Sachs defect - impression of the dorsolateral part of the humeral head

these accompanying injuries are responsible for recurrent dislocations in young people

Clinical symptoms[edit | edit source]

Skiagram of dislocation of the shoulder joint

Hippocrates Maneuver

deformity in the shoulder area (antalgic posture, protruding acromion, empty joint socket, dislocated head, inability to abduct)
innervation and peripheral blood supply must be examined

Diagnostics[edit | edit source]

RTG image (always necessary to rule out fracture, before and after reduction) anteroposterior, axial, Y-projection
for recurrent dislocations and chronic instability CT or MRI

Complications[edit | edit source]

fracture (mainly avulsion of the greater humerus or fracture of the neck of the humerus - luxation fracture) - X-ray
supraspinatus tendon rupture - it is not possible to bend between 60°-120°^[1]
nerve injury' (n. axillaris) – anesthesia above the deltoid tuberosity
vessel injury' (a. + v. axillaris) – peripheral pulsation, venostasis
recurrent luxation (luxatio recidivans) - based on a Bankart lesion or a Hill–Sachs defect

Treatment[edit | edit source]

Conservative therapy[edit | edit source]

reposition in general anaesthesia, only in case of recurrent dislocations and good cooperation of the patient can reposition without anaesthesia
repositioning maneuvers with pull + counter-pull: according to Arlt or Hippocrates, manipulation is less suitable (according to Kocher)
after reposition, perform X-ray again
fixation (Desault's or Gilchrist's bandage, orthosis) for no longer than 3 weeks, then mobilization in a sling

Operative therapy[edit | edit source]

for irreparable dislocations (obsolete dislocations, interposition of soft tissues) or dislocation fractures, for recurrent dislocations with tearing of the glenoid labrum (Bankart's lesion)
arthroscopically or through the open route
in case of relapses, consider reconstruction (capsules, pits, proc. coracoideus) according to Eden-Hybinette

Links[edit | edit source]

References[edit | edit source]

PASTOR, Jan. Langenbeck's medical web page [online]. [cit. 2010]. <https://langenbeck.webs.com/>.

ZEMAN, Miroslav, et al. Special Surgery. 2. edition. Prague : Galen, 2004. 575 pp. ISBN 80-7262-260-9.

References[edit | edit source]

↑ ^a ^b VISHŇA, Peter – HOCH, George, et al. Traumatology of adults : textbook for medical schools. 1. edition. Prague : Maxdorf, 2004. 157 pp. pp. 40–42. ISBN 80-7345-034-8.

[Višňa-1] VISHŇA, Peter – HOCH, George, et al. Traumatology of adults : textbook for medical schools. 1. edition. Prague : Maxdorf, 2004. 157 pp. pp. 40–42. ISBN 80-7345-034-8.

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