CAUSE

  • Forced abduction and external rotation of the shoulder

  • Common in young adults from sports or road accidents

  • Can be recurrent

 

APPEARANCE

  • Slight abduction

  • Appears square with prominent ‘ Acromion’

 

COMPLICATIONS

  • Axillary nerve damage- Look for sensory loss over the upper lateral part of upper arm

  • Damage to posterior cord of brachial plexus- Assess by testing wrist extension by the radial nerve

  • Axillary artery damage- Check by palpating brachial pulse

  • Fracture upper humerus- Look for it in the X-ray

 

MANAGEMENT

  • Give morphine in severe pain

  • Xray the shoulder always to avoid missing humeral head fracture

 

X-RAY APPEARANCE

  • The humeral head is displaced medially and anteriorly with loss of contact with glenoid fossa in anteroposterior view

  • Rule out humeral head fracture- in case of fracture, do not reduce. Discuss with orthopaedic surgeons beforehand

 

REDUCTION

  • Can be done with morphine or under general anaesthesia as required

 

KOCHER’S MANOEUVRE

  • Gentle traction is applied to the arm flexed at the elbow and then external rotation is slowly exerted

  • The shoulder should lock back during external rotation. If it does not when 90 degrees is reached adduct the arm across the chest and internally rotate it

  • The shoulder is felt to slip back

  • If not, repeat the whole process again

 

  • After reduction, place the arm in a sling strapped to the body or enclosed under patients clothes to prevent external rotation

  • Always repeat the shoulder X-ray to make sure its back in place.

  • Test for neurovascular damage as above

  • Follow up this patient with fracture clinic appointment in 2 weeks time.

 

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