Shoulder Dislocations and Anatomy

Study Notes

Joints dislocation is a common injury, particularly the shoulder.
Shoulder dislocation is frequent due to the shallow glenoid socket and wide range of movement.
Types of shoulder dislocation include anterior, posterior, and inferior.
Anterior dislocation is the most common type, often resulting from a fall or excessive abduction and external rotation.
Posterior dislocation is rare, often associated with internal rotation forces.
Inferior dislocation is also rare.

Shoulder stability relies on soft tissues, not inherent bony structure.
The rotator cuff is a dynamic stabilizer, using muscle tension and compression.
The glenohumeral ligament (GHL) and capsule are static stabilizers, providing ligament tightening.
Glenoid bone stock is limited.

TUBS: Traumatic, unidirectional, Bankart lesion, surgery required.
AMBRI: Atraumatic, multidirectional, bilateral, rehabilitation is the primary treatment, sometimes requiring inferior capsular shift surgery.
Traumatic dislocations are further categorized as anterior, posterior, and multidirectional.

Traumatic anterior dislocation involves avulsion of the glenoid labrum and capsule, stretching of the capsule, and indentation of the posterolateral humeral head.

X-rays and MRI scans are used in diagnosis to assess injury severity and associated fractures.
Radiology examines the bone structure for any dislocation or associated fractures.
MRI examines the soft tissues to identify any tears in the rotator cuff, capsule, or glenoid labrum.

Non-operative treatment (closed reduction) is usually the initial approach, often performed under anesthesia. It involves manually repositioning the humeral head.
Post-reduction, immobilisation is important for healing, along with ice/heat and/or non-steroidal anti-inflammatory drugs (NSAIDs).
Physiotherapy is crucial for restoring range of motion and strengthening the shoulder muscles, after the initial recovery period.
Surgical treatment is indicated for old or recurrent dislocations or if non-operative methods fail.
Surgical techniques include open or arthroscopic procedures.

Taking care and avoiding falls.
Wearing protective gear in contact sports.
Regular exercise to maintain strength and flexibility in shoulder joints and muscles.

Elbow dislocation is a common injury in children and young adults, with posterior dislocation being the most frequent.
This is mostly caused by falls on an outstretched hand.
Ligaments and capsule of the elbow are damaged during dislocation.
The medial and lateral collateral ligaments, along with the anterior capsule are affected.

Urgent closed reduction under general anesthesia, using gradual gentle longitudinal traction to reposition the bones.
The hand of the surgeon manipulates the radius and ulna and moves them into their normal position.
The elbow is immobilized for several weeks in a cast.
Rehabilitation, including gentle exercises and range of motion activities, will start soon after to avoid myositis ossificans and stiffness.

Lunate dislocation is common in wrist dislocations.
It may lead to carpal tunnel syndrome (CTS).
Open reduction is sometimes needed for lunate dislocations.
Hand rehabilitation is important for maintaining hand function and preventing stiffness.