POSTERIOR DISLOCATION OF SHOULDER
APPEARANCE
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This is relatively uncommon.
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Occurs with electrocution or seizures or direct blow to shoulders
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The am is held adducted and internally rotated and the greater tuberosity if the humerus feels prominent
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External rotation is painful and limited
MANAGEMENT
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Give sufficient analgesics. Morphine with antiemetic like metoclopramide
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XRAY the affected shoulder. Get and Anteroposterior and lateral view
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On the AP view, look for the ‘light bulb sign due to internally rotated humerus displaying a globular head and for loss of parallelism between the humeral head and glenoid fossa
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On the axillary lateral view look to the humeral head lying behind the glenoid
REDUCTION
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Perform a reduction using midazolam intravenous and keep all resuscitation equipment ready
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Apply traction to the arm and abduct to 90 degrees
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Gently externally rotate the arm
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After reduction, place the arm in a sling and repeat the X-ray to confirm.
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If the reduction is unsafe, unstable refer to orthopaedic surgeons immediately
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Refer the patient to fracture clinic and discharge on regular analgesics.