Overview
What is the most common large-joint dislocation seen in the emergency department (ED)?
What are the types of anterior dislocations?
What is the prevalence of posterior shoulder dislocations?
What is the prevalence of inferior glenohumeral dislocation (luxatio erecta humeri)?
How are shoulder dislocations reduced?
Which shoulder dislocations should be referred to an orthopedic surgeon for correction?
What are the indications for closed reduction of posterior shoulder dislocations?
What are the indications for closed reduction of inferior glenohumeral dislocations?
When is standard closed reduction of an anterior shoulder dislocation contraindicated?
What are the contraindications for standard closed reduction of a posterior shoulder dislocations?
How is the reduction approach determined for shoulder dislocation?
What is the clinical presentation of anterior shoulder dislocation?
Which exams are performed prior to attempting reduction of anterior shoulder dislocations?
What causes posterior shoulder dislocations?
Which exams are performed prior to attempting reduction of posterior shoulder dislocations?
What is the clinical presentation of inferior glenohumeral dislocations?
When is open reduction considered for anterior shoulder dislocations?
How can injuries be prevented during reduction of shoulder dislocation?
What is the most common adverse outcome after reduction of shoulder dislocation?
What are the possible complications of shoulder dislocations?
Which injuries are associated with inferior glenohumeral dislocations?
Periprocedural Care
What is the role of radiography in in the assessment of anterior shoulder dislocation?
Which factors have been associated with clinically significant fractures in shoulder dislocations?
What is the role of ultrasonography in the diagnosis of shoulder dislocation?
How are posterior shoulder dislocations diagnosed?
What are the limitations of a radiography AP view when evaluating posterior shoulder dislocations?
Which radiographic views should be used to diagnose posterior shoulder dislocations?
What is the clinical presentation of posterior shoulder dislocation?
What is the clinical presentation suggestive of an inferior shoulder dislocation?
Which radiograph views should be obtained for evaluation of inferior shoulder dislocations?
Which equipment is required for the reduction of shoulder dislocations?
When are pain control and muscle relaxation indicated for reduction of dislocated shoulders?
What are the pain control options for reduction of anterior shoulder dislocation?
When is procedural sedation used in reduction of shoulder dislocations?
How is intra-articular anesthetic injection performed in the reduction of shoulder dislocations?
What is the efficacy of intra-articular lidocaine in the reduction of shoulder dislocations?
What is the role of brachial plexus nerve blocks in the treatment of shoulder dislocations?
How are nerve blocks performed in the reduction of shoulder dislocations?
How is pain controlled during reduction of an inferior shoulder dislocation?
How is the degree of anesthesia determined for the reduction of inferior shoulder dislocations?
Technique
Which factors may vary among reduction techniques for shoulder dislocations?
Which techniques are commonly used to reduce anterior shoulder dislocations?
How are posterior shoulder dislocations typically reduced?
Which techniques are commonly used to reduce inferior shoulder dislocations?
Which maneuvers facilitate most techniques for the reduction of shoulder dislocations?
What are the signs of successful reduction of shoulder dislocations?
Why is neurovascular exam required before and after reduction of shoulder dislocations?
When is orthopedic consultation necessary for the reduction of shoulder dislocations?
How is the Stimson maneuver performed for the reduction of shoulder dislocations?
What can facilitates the reduction of shoulder dislocations during a Stimson maneuver?
What are the advantages of the Stimson maneuver for the reduction of shoulder dislocations?
What are the disadvantages of the Stimson maneuver for the reduction of shoulder dislocations?
How is scapular manipulation performed for the reduction of shoulder dislocations?
What are the advantages of scapular manipulation for the reduction of shoulder dislocation?
What are the disadvantages of scapular manipulation for the reduction of shoulder dislocation?
How is external rotation performed for the reduction of shoulder dislocation?
What are the advantages of external rotation for the reduction of shoulder dislocation?
What are the disadvantages of external rotation for the reduction of shoulder dislocation?
How is the Milch technique performed for the reduction of shoulder dislocation?
What are the advantages of the Milch technique for the reduction of shoulder dislocation?
What are the disadvantages of the Milch technique for the reduction of shoulder dislocation?
How is the Spaso technique performed for the reduction of shoulder dislocation?
What are the advantages of the Spaso technique for the reduction of shoulder dislocation?
What are the disadvantages of the Spaso technique for the reduction of shoulder dislocation?
How is the traction-countertraction technique performed for the reduction of shoulder dislocation?
How is traction applied for the reduction of shoulder dislocation?
How is the axial (inline) traction technique performed for the reduction of shoulder dislocation?
How is the two-step reduction technique performed for the reduction of shoulder dislocation?
Medications
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Ultrasound probe placement for viewing glenohumeral joint via posterior approach.
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Ultrasound image of normal (right) and anteriorly dislocated shoulder (left). Arrow points to humeral head. Image courtesy of Michael A Secko, MD, RDMS.
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Reduction of shoulder dislocation: Stimson maneuver.
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Reduction of shoulder dislocation: Stimson maneuver.
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Reduction of shoulder dislocation: scapular manipulation. Hand placement.
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Reduction of shoulder dislocation: scapular manipulation. Sitting position.
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Reduction of shoulder dislocation: external rotation.
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Reduction of shoulder dislocation: Milch technique.
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Reduction of shoulder dislocation: Spaso technique.
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Reduction of shoulder dislocation: traction and countertraction.
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Reduction of shoulder dislocation: traction and countertraction.
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Classic presentation of inferior shoulder dislocation. Affected arm is hyperabducted, with elbow flexed and forearm resting on top of head.
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"Regimental badge" area. Examine pinprick sensation to this area to assess axillary nerve sensory function.
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Reduction of shoulder dislocation: axial traction and countertraction. Axial traction is applied to arm, and parallel countertraction is applied with sheet wrapped over shoulder. Increasing degree of abduction (if possible) and applying cephalad pressure to displaced humeral head (star) can aid in reduction.
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Reduction of shoulder dislocation: axial traction and countertraction. After inferior dislocation is reduced, arm is adducted, supinated, and immobilized for postreduction radiography.
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Reduction of shoulder dislocation: two-step reduction. Step 1, part 1. Push anteroinferiorly on midhumerus with hand A while pulling posteriorly on medial condyle with hand B.
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Reduction of shoulder dislocation: two-step reduction. Step 1, part 2. After conversion of inferior dislocation to anterior dislocation, adduct arm and grasp patient's wrist.
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Reduction of shoulder dislocation: two-step reduction. Step 2. Hand A holds patient's arm in adduction while hand B externally rotates arm to reduce now anteriorly dislocated humeral head.
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Anteroposterior radiograph of left shoulder shows posterior glenohumeral dislocation. Impaction of humeral head on posterior glenoid results in reverse Hill-Sachs defect (trough sign) on anterior aspect of humeral head. Image courtesy of Dr M A Png, Singapore General Hospital.
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Axial spin-echo T1-weighted magnetic resonance arthrogram of right shoulder shows tear of posterior glenoid labrum (arrow) and reverse Hill-Sachs defect (arrowhead). Patient had previous posterior dislocation.
