ANTERIOR DISLOCATION OF SHOULDER
CAUSE
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Forced abduction and external rotation of the shoulder
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Common in young adults from sports or road accidents
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Can be recurrent
APPEARANCE
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Slight abduction
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Appears square with prominent ‘ Acromion’
COMPLICATIONS
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Axillary nerve damage- Look for sensory loss over the upper lateral part of upper arm
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Damage to posterior cord of brachial plexus- Assess by testing wrist extension by the radial nerve
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Axillary artery damage- Check by palpating brachial pulse
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Fracture upper humerus- Look for it in the X-ray
MANAGEMENT
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Give morphine in severe pain
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Xray the shoulder always to avoid missing humeral head fracture
X-RAY APPEARANCE
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The humeral head is displaced medially and anteriorly with loss of contact with glenoid fossa in anteroposterior view
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Rule out humeral head fracture- in case of fracture, do not reduce. Discuss with orthopaedic surgeons beforehand
REDUCTION
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Can be done with morphine or under general anaesthesia as required
KOCHER’S MANOEUVRE
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Gentle traction is applied to the arm flexed at the elbow and then external rotation is slowly exerted
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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
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The shoulder is felt to slip back
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If not, repeat the whole process again
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After reduction, place the arm in a sling strapped to the body or enclosed under patients clothes to prevent external rotation
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Always repeat the shoulder X-ray to make sure its back in place.
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Test for neurovascular damage as above
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Follow up this patient with fracture clinic appointment in 2 weeks time.