Description

• A dislocated shoulder occurs when the head of humerus is out of the glenoid cavity. Because the head of humerus is substantially larger than the glenoid fossa, shoulder dislocation is the most common type of joint dislocation
• It occurs more commonly in adults, and is rare in children
• A fall on an out-stretched hand with the shoulder abducted and externally rotated is the common mechanism of injury

Classification:

Anterior dislocation — the head of the humerus comes out of the glenoid cavity and lies anteriorly. It may be further classified in to 3 subtypes

• Preglenoid: The head lies in front of the glenoid
• Sub coracoid: The head lies below the coracoid process
• Sub clavicular: The head lies below the clavicle

Posterior dislocation — In this injury, the head of the humerus comes to lie posteriorly, behind the glenoid

Inferior dislocation– This is a rare type, where the head comes to lie in the sub glenoid position

Types

• Severe shoulder pain
• Instability & weakness of shoulder area
• Inability to move shoulder
• Swelling
• Bruising
• Numbness & tingling ( around shoulder, arms, fingers)
• Empty glenoid fossa: A palpable dent may be present at the point where the head of the humerus is supposed to lie

Anterior or Anterior-inferior dislocation

• The humeral head can usually be palpated below the coracoid process
• The arm is typically held in external rotation and slight abduction

Posterior dislocation

• Prominence of the posterior shoulder with anterior flattening
• Prominent coracoid process
• The arm is held in adduction and internal rotation, with the patient unable to actively rotate it in the outward direction

Inferior dislocation

• The arm is held above the head, with the patient unable to actively adduct the arm
• Neurologic dysfunction, especially with involvement of the axillary nerve, is common

Investigation

On examination

• The patient keeps his arm abducted
• The normal round contour of the shoulder joint is lost, and it becomes flattened
• On careful inspection, one may notice fullness below the clavicle due to the displaced head. This can be felt by rotating the arm

Anterior dislocation

• Dugas' test: Inability to touch the opposite shoulder
• Hamilton ruler test: Because of the flattening of the shoulder, it is possible to place a ruler on the lateral side of the arm. This touches the acromion and lateral condyle of the humerus simultaneously 

Shoulder x‑ray

• AP view and lateral view (Y view) to confirm dislocation and exclude fracture
• For posterior shoulder dislocation: axillary and/or scapular lateral views (Y view)
• The light bulb sign is diagnostic of posterior shoulder dislocation
• Hill-Sachs lesion: Seen in 35–40 % of patients with an anterior dislocation

MRI

• Indicated to assess soft tissue damage or if a Hill-Sachs lesion is present
• Bankart lesion: injury of the anterior inferior lip of the glenoid labrum due to traumatic anterior shoulder dislocation

Treatments

• Reduction- Kocher’s manoeuvre or Hippocrates manoeuvre
• Immobilisation of the shoulder in a chest-arm bandage for 3 weeks
• Rehabilitation
• Analgesics
• Surgery if needed

Ayurvedic Treatment

Internal medicines

• Dhanwanthara Kashaya
• Musthadimarma Kashaya
• Laksha guggulu
• Gandha taila
• Yogarajaguggulu
• Bala taila : in neurological complications

Procedure

• Reduction of dislocated shoulder
• Swasthika Bandhana with sling(for 6 weeks)
• Murivenna over bandaged area

Department

Salya Tantra