Makindo Medical Notes

Always examine and document axillary nerve function. The axillary nerve runs close to the shoulder joint and can be injured during dislocation, leading to numbness in the deltoid area or weakness in shoulder movement.

About

• The shoulder is the most commonly dislocated major joint.
• Typically, the head of the humerus displaces inferiorly or anteriorly.
• Posterior dislocations are uncommon and often associated with seizures or electrical shocks.

Types

Clinical Presentation

• Arm held in an internally rotated and adducted position.
• Pain with loss of normal rounded appearance of the shoulder.
• Limited or no range of motion.
• Swelling and bruising around the shoulder joint.
• Numbness or weakness in the arm or hand due to possible nerve involvement.
• Muscle spasms as the shoulder muscles contract to protect the joint.

Complications

• Axillary nerve damage is possible due to its proximity to the surgical neck of the humerus. Document sensation over the "shoulder badge" area before and after manipulation to confirm nerve integrity.

Investigations

• An AP film or trans-scapular Y view is recommended for accurate visualization.

Management

• Immobilization: Broad arm sling. Reduction may require sedation or general anaesthesia.
• Closed Reduction: Modified Kocher's technique:
  • Flex the elbow and rotate the forearm outward.
  • Then, swing the elbow medially across the trunk, which levers the humeral head back into place.
  • Hippocratic method can also be used, applying the heel to the axilla with traction and adduction.
• Open Reduction: If reduction fails manually or fractures are present, surgical intervention is necessary.
• Post-Reduction Care: Immobilize the shoulder in a sling or shoulder immobilizer for 1 to 3 weeks, depending on age and injury severity.
• Rehabilitation: Gradual physical therapy to restore range of motion, strength, and stability. Begin with passive movements, advancing to active strengthening exercises.
• Surgical Intervention: May be required for recurrent dislocations, large labral tears, significant fractures, or severe soft tissue damage during initial dislocation.