Shoulder dislocations March 2018 | by EMauthor •Suspect clinically from mechanism of injury and the alteration in the contour of the shoulder •Always administer adequate analgesia before x-ray, the best is intravenous opiate titrated to the patient’s need •Remember to keep NBM as even a drink will increase sedation risk •Always assess neurovascular function especially axillary nerve before and after manipulation •AP view and either an axial or alternative views will help to pick up posterior dislocation which can be missed on one view •Examine the x-ray carefully for associated fractures (greater tuberosity, glenoid rim and humeral neck) Anterior dislocation •Reduce under iv sedation with cardiac monitoring and suitable senior supervision •Thin elderly patients, intoxicated patients or 'recurrent dislocaters' may be reduced with Nitrous Oxide inhalation only, if the patient is happy with this. •There are several techniques for reduction, the most popular are Kocher, Milch, and external rotation, these will be taught hands on •Usually immobilise with Lancaster type Velcro sling •Always advise early exercise of the distal joints •Fracture clinic follow up Posterior dislocation •Suspect in epileptics and severe injuries around the shoulder •Reduce under iv sedation by traction on abducted arm in 90 degrees followed by external rotation, seek senior help •Post reduction care is similar, however, if reduction unstable refer to orthopaedics Luxatio erecta (vertical dislocation) •The arm will be held in abduction •Very painful •Seek senior help for reduction Fracture dislocation •Greater tuberosity fracture, treat the same as isolated dislocation and assess the position of greater tuberosity segment after reduction •Neck of humerus fracture, will need GA +/- open reduction, refer to orthopaedics |
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