
Anterior Dislocation (humeral head comes to lie anterior, medial and slightly inferior to its normal location and glenoid fossa).
Following an acute anterior glenohumeral dislocation:
- Arm held in an abducted and ER position
- Loss of normal contour of the deltoid and acromion prominent posteriorly and laterally
- Humeral head palpable anteriorly
- All movements limited and painful
- Palpable fullness below the coracoid process and towards the axilla
- Possible damage to rotator cuff musculature and bone.
- Vascular injuries may result from traction of the axillary blood vessels, resulting in a reduced pulse pressure or a transient coolness in the hands.
- Peripheral nerve injuries are common due to traction if the brachial plexus.
PSD with-reverse-hill-sachs-and-reverse-bankart-lesions
Posterior Dislocation
With acute posterior glenohumeral dislocation:
- Arm is abducted and IR
- May or may not lose deltoid contour
- May notice posterior prominence head of humerus
- Tear of subscapularis muscle (weak or cannot internally rotate)
- Neurovascular compromise is rare, but posterior shoulder instability may result from associated glenolabral and capsular injuries.
Posterior dislocations are hard to reduce, attempts at closed reduction need be performed in consultation with a treating orthopaedic surgeon. If the shoulder dislocation was ≥3 weeks ago (common in feeble elderly patients) or if their is reverse Hill-Sachs defect involving >20% of the articular surface, then the closed reduction is contraindicated.
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J. Press
Physiotherapist