GLENOHUMERAL DISLOCATION Shoulder Dislocation

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GLENOHUMERAL DISLOCATION Shoulder Dislocation

• Shoulder dislocations were described in the Edwin
  Smith Papyrus about 3000 BC. Paintings on the
  wall of the tomb of Ramses II appear to depict
  closed reduction of a shoulder dislocation.

At the height of ancient Greek civilization,
Hippocrates clearly described glenohumeral
disloca-tion, recommended closed manipulation,
and discussed operative trearment for recurrent
dislocation.
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EpidemioIogic studies

• Hovelius reported that the incidence of shoulder
  dislocations between the ages of l8 and 70 years
  in Sweden was l.7.
• Most studies have noted a 2 to 5 times greater
  incidence of dislocations among males compared
  with females.
• Although they occur at all ages, the greatest
  number of initial dislocations occur between ages
  l0 and 20 years.
• However, fractures, rotator cuff injuries, and
  neurovascular injuries are more common in older
  individuals.

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The glenohumeral joint is the most mobile and
most commonly dislocated major joint. The
tremendous range of motion is achieved at the
expense of intrinsic skeletal stability. Kazar
found that 45 of dislocations involve the
shoulder. 86 of shoulder dislocations were
glenohumeral dislocations.

• Normal glenohumeral anatomy

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Direction of Dislocation Anterior.

• The vast majority of glenohumeral dislocations
  are anterior. In Rowe's series, 98 of
  dislocations were anterior and 2 were posterior.
  
• Many references have discussed the different
  positions of the humeral head in anterior
  dislocahons.
• Subcoracoid dis-locations are the most common,
  followed by subglenoid, subclaviculap and
  intrathoracic. Intrathoracic dislocationsare
  exceedingly rare.

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Anterior Glenohumeral DislocationMECHANIISM OF
INJURY

• 95 of the dislocations were classified as
  traumatic, it is very age dependent. In the
  younger age groups, athletic injures are common,
  such as from athletic trauma or a fall, whereas
  in older persons, often the result of falls.
• The indirect mechanisms are usually caused by
  varying degrees of abduction, extension, and
  external rotation forces on the arm. Inferior
  dislocation is the result of a hyperabduction
  force that levers the proximal humerus against
  the acromion and out of the glenoid inferiorly.

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Mechanism of injury

• B Anterior labral detachment from the glenoid
  rim. C Anterior labral datachment in which the
  periosteum of the anterior neck of the scapula
  remains attached to the labrum. D Disruption of
  the glenohumeraI capsule and anterior ligaments
  at the humeraI insertion. E Fracture Of the
  anterior glenoid rim. F Avulsion Of the great
  tuberosity (common in older patients).
  G.Posterior capsular disruption and rotator cuff
  tear.

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PATHOLOGY

• Throughout the orthopaedic literature of the 20th
  century,there has been discussion about the
  "essential lesion" of recurring anterior
  glenohumeral dislocation, credited with
  identifying the importance of detachment of the
  labrum and the anterior gleno-humeral capsule
  from the anterior rim of the glenoid.

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Hippocratic technique

• The heel of the foot is placed against the
  humeral head in the axilla.
• And longitudinal traction is applied to the arm
• It was predominant 2000 years.
• Traction and leverage
• Less traumatic

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Kocher maneuver

• The supine position
• Holding the elbow
• Externally rotate humerus
• Neurovascular complications and humeral fractures.

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Stimson techniqe

• The patient is positioned prone
• The arm is allowed to hang down.
• 10 lb of weight
• Some form of relaxation is usually required.