Dislocated shoulder

Anterior (forward)

Over 95% of shoulder dislocation cases are anterior. Most anterior dislocations are sub-coracoid. Sub-glenoid; subclavicular; and, very rarely, intrathoracic or retroperitoneal dislocations may occur.[2]

It can result in damage to the axillary artery.[3]
[edit] Posterior (backward)

Posterior dislocations are occasionally due to electrocution or seizure and may be caused by strength imbalance of the rotator cuff muscles. Posterior dislocations often go unnoticed, especially in an elderly patient[4] and in the unconscious trauma patient.[5] An average interval of 1 year was discovered between injury and diagnosis of posterior dislocation in a series of 40 patients.[6]
[edit] Inferior (downward)

Inferior dislocation is the least likely form, occurring in less than 1% of all shoulder dislocation cases. This condition is also called luxatio erecta because the arm appears to be permanently held upward or behind the head.[7] It is caused by a hyper abduction of the arm that forces the humeral head against the acromion. Inferior dislocations have a high complication rate as many vascular, neurological, tendon, and ligament injuries are likely to occur from this kind of dislocation.
[edit] Signs

* Significant pain, which can sometimes be felt past the shoulder, along the arm.
* Inability to move the arm from its current position, particularly in positions with the arm reaching away from the body and with the top of the arm twisted toward the back.
* Numbness of the arm.
* Visibly displaced shoulder. Some dislocations result in the shoulder appearing unusually square.
* No bone in the side of the shoulder showing shoulder has become dislocated.

[edit] Treatment
[edit] Initial

Prompt professional medical treatment should be sought for any suspected dislocation injury. Usually, a dislocated shoulder is kept in its current position by use of a splint or sling (however, see below). A pillow between the arm and torso may provide support and increase comfort. Strong analgesics are needed to allay the pain of a dislocation and the anxiety associated with it, and hence, conservative measures of pain relief, should not be attempted.

Emergency department care is focused on returning the shoulder to its normal position via processes known as reduction. Normally, closed reduction, in which several methods are used to manipulate the bone and joint from the outside, is used. A variety of techniques exist, but some are preferred due to fewer complications or easier execution.[8] In cases where closed reduction is not successful, surgical open reduction may be needed.[9] Following reduction, X-Ray imaging is often used to ensure that the reduction was successful and there are no fractures. The arm should be kept in a sling or immobilizer for several days, preferably until orthopedic consultation. Hippocrates' and Kocher's method are rarely used anymore. Hippocrates used to place the heel in the axilla and reduce shoulder dislocations. Kocher's method if performed patiently and slowly can be performed without anesthesia and if done correctly does not cause pain. Traction is applied on the arm and it is abducted. Then, it is externally rotated, and the arm is adducted following which it is internally rotated and maintained in the position with the help of a sling. A chest x-ray should be taken to confirm whether the head of humerus has reduced back into the glenoid cavity.
[edit] Post-reduction: immobilisation in external versus internal rotation

For thousands of years, treatment of anterior shoulder dislocation has included immobilisation of the patient's arm in a sling, with the arm placed in internal rotation (across the body). However, three studies, one in cadavers and two in patients, suggest that the detachment of the structures in the front of the shoulder is made worse when the shoulder is placed in internal rotation to be seen. By contrast, the structures are realigned when the arm is placed in external rotation. New data suggest that if the shoulder is managed non-operatively and immobilised, it should be immobilised in a position of external rotation.[10][11]

Another study found that conventional shoulder immobilisation in a sling offered no benefit[12]
[edit] Surgery

Some cases require non-emergency surgery to repair damage to the tissues surrounding in the shoulder joint and restore shoulder stability. Arthroscopic surgery techniques may be used to repair the glenoidal labrum, capsular ligaments, biceps long head anchor or SLAP lesion and/or to tighten the shoulder capsule.[13]

The time-proven surgical treatment for recurrent anterior instability of the shoulder is a Bankart repair.[14] Surgery to anatomically and securely repair the torn anterior glenoid labrum and capsule without arthroscopy can lessen pain and improve function for active individuals. When the front of the shoulder socket has been broken or worn, a bone graft may be required to restore stability.[15] When the shoulder dislocates posteriorly (out the back), a surgery to reshape the socket may be necessary. Surgery to build up the back of the glenoid socket using an osteotomy and graft can restore shoulder anatomy and lessen pain and improve function. Conversely, there are new procedures that should be investigated as a possible alternative to open surgery