Shoulder Dislocation

Case: 29 year old female dislocated L shoulder while swimming at lake.

Tapa: When assessing dislocations, you want to make sure you document neurovascular function prior to any therapeutic measures. With a shoulder dislocation it is important to check axillary nerve function. Sensation can be assessed over the deltoid, and motor function can be attempted with abduction.

X-Rays in at least 2 planes should be taken to ensure you have localized the dislocation correctly (over 90% of shoulder dislocations are anterior).

Left: Scapular Y-View showing an anterior dislocation.

There are numerous techniques used to for anterior shoulder reductions. The following video link from the good folks at Vanderbilt University illustrates a few of them: http://vimeo.com/8605660

After you believe the shoulder has been reduced, a simple test you can perform is to see if the patient can use their affected arm to reach across and touch their opposing shoulder. If they are successful, there is a good chance their arm has been successfully reduced. Post-reduction x-rays may be obtained to confirm placement.

The patient's arm should be placed in a sling, and the patient should follow up at an orthopedic clinic. It is important to instruct the patient that without physical therapy or surgery, the shoulder becomes easier to dislocate each time thereafter.