SHOULDER DISLOCATION

Prepared by: Vincent Aguilar

Condition
occurs when the humerus separates from the scapula at the glenohumeral joint
The shoulder joint has the greatest range of motion of any joint in the body Approximately half of major joint dislocations seen in emergency departments are of the shoulder.

What is subluxation?
 a partial dislocation of a joint  occurs when the two joint (articular) surfaces have lost their usual contact  50% subluxation- normally opposing articular surfaces have lost half their usual contact; joint is partially dislocated  100% subluxation- the articular surfaces have lost all of their contact

Anatomy of the Shoulder Joints and the Ligaments

Structures Giving Stability to the Joint

 Rotator cuff muscles  holds the head of the humerus in the glenoid fossa.  Shoulder labrum & capsule  Labrum- cartilage- like ring surrounding the glenoid  Capsule- series of ligaments that connects the humerus to the glenoid

Structures Giving Stability to the Joint

Factors which lead to instability
Ability of the labrum and ligaments to stretch and tear
Leads to greater and more painful shoulder conditions especially dislocation and subluxation Free movement of joint shallowness of the glenoid cavity laxity of the fibrous capsule

Rotator Cuff Muscles

 Supraspinatus
 acts strongly when a heavy weight is carried with the upper limb adducted (e.g., when carrying a heavy suitcase).  Assists deltoid muscle in abducting arm at shoulder joint

 Infraspinatus
 Rotates arm laterally at shoulder point  helps the other muscles of the rotator cuff to stabilise the shoulder joint

Rotator Cuff Muscles

 Subscapularis
 rotates the arm medially  helps the other muscles of the rotator cuff to stabilize the shoulder joint.

 Teres Minor
 laterally rotates the arm  assists in its adduction

Anatomical Structure of Joint that is Affected

 Glenohumeral joint
 main joint of the shoulder  generic term shoulder joint  a ball and socket joint- allows the arm to rotate in a circular fashion or to hinge out and up away from the body

 formed by the articulation between the head of the humerus and the lateral scapula (specifically the glenoid fossa of the scapula)
Acromioclavicular joint common injury to the AC joint is dislocation, often called AC separation or shoulder separation not the same as a "shoulder dislocation," which refers to dislocation of the glenohumeral joint

Ligament, Muscle & Nerve that is Damaged

Glenohumeral ligaments
Main source of stability for the shoulder They are the superior, middle and inferior glenohumeral ligaments help hold the shoulder in place and keep it from dislocating

 Axillary Nerves
supplies the Deltoid muscle Most commonly stretched with shoulder dislocations

 Rotator cuff
group of muscles and their tendons that act to stabilize the shoulder holds the head of the humerus (ball) in the glenoid fossa (socket).

Sporting Events/ Activities Prone or at Risk in Having Shoulder Dislocation

    
Rugby Martial arts Baseball Volleyball Lifting weights over the head

Signs & Symptoms

 Pain (sometimes felt past the shoulder, along the arm)  Inability of movement  Numbness of arm  Visibly displaced shoulder  Bruising  Weakness

First Aid Management

 If a sling is not available, rig one by tying a long piece of cloth in a circle (a bed sheet or towel may do nicely).  A pillow placed between the arm and body may also help support the injured shoulder.

Sources:
http://download.videohelp.com/vitualis/med/shldrjnt.htm http://www.drbradleyschmidt.com/newsletter/1109/newsLetter1109.html http://www.shoulderdoc.co.uk/article.asp?article=1179&section=857 http://en.wikipedia.org/wiki/Shoulder#Muscles http://www.physioroom.com/injuries/shoulder/dislocated_shoulder_sum.php http://en.wikipedia.org/wiki/Dislocated_shoulder http://www.emedicinehealth.com/shoulder_dislocation/page5_em.htm http://www.shoulderdoc.co.uk/article tile.asp?article=50&section=12&tile=3 Book: Essentials of Anatomy and Physiology by Gerard Tortora & Bryan Derrickson