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Shoulder dislocation and reduction

Author
Scott C Sherman, MD
Section Editor
Allan B Wolfson, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM

INTRODUCTION

Shoulder dislocations account for 50 percent of all major joint dislocations [1-5]. Anterior dislocation is most common, accounting for 95 to 97 percent of cases. Posterior dislocation accounts for 2 to 4 percent, and inferior dislocation (ie, luxatio erecta, which means "to place upward") accounts for 0.5 percent [6].

This topic review will discuss the mechanism of injury, evaluation, and reduction of shoulder dislocations. Evaluation of the patient with shoulder pain and other shoulder injuries are discussed elsewhere. (See "Evaluation of the patient with shoulder complaints" and "Acromioclavicular joint injuries ("separated" shoulder)" and "Frozen shoulder (adhesive capsulitis)" and "Glenohumeral osteoarthritis" and "Multidirectional instability of the shoulder" and "Presentation and diagnosis of rotator cuff tears" and "Shoulder impingement syndrome".)

CLINICAL ANATOMY

The shoulder is an inherently unstable joint (figure 1A-C and figure 2 and figure 3 and figure 4). The glenoid is shallow, allowing for a wide range of motion, with only a small portion of the humeral head articulating with the glenoid in any position (figure 5). The glenoid labrum is a fibrocartilaginous structure that surrounds the glenoid and inserts into the edge of the joint capsule. The distal portion of the joint capsule attaches to the humeral neck. The inferior glenohumeral ligament represents the anterior-inferior portion of the capsule (figure 2). This ligament is thicker than the rest of the joint capsule and provides the strongest impediment to anterior dislocation.

The rotator cuff muscles (figure 6)provide additional support of the glenohumeral joint. The subscapularis muscle lies anterior to the joint capsule and acts as a secondary support resisting dislocation. Posteriorly the supraspinatus, infraspinatus, and teres minor pull the humeral head into the glenoid and help to prevent it from anterior subluxation [7].

The axillary nerve, the nerve most often injured with shoulder dislocations, runs inferiorly to the humeral head and wraps around the surgical neck of the humerus. It innervates the deltoid and teres minor muscles and the skin overlying the lateral shoulder ("shoulder badge" distribution). Shoulder anatomy is discussed in greater detail elsewhere. (See "Evaluation of the patient with shoulder complaints", section on 'Anatomy and biomechanics'.)

                             

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Literature review current through: Nov 2016. | This topic last updated: Mon Sep 19 00:00:00 GMT+00:00 2016.
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