Shoulder Dislocations

Shoulder dislocations commonly seen in young individuals occur as a result of direct or indirect impact over the shoulder joint. There are two broad types of dislocations described; based on the position of the Humeral head.
Anterior dislocations are more common. Posterior dislocation are a rare entity; often seen in epileptics. After an impact, the patient feels sudden give way in the shoulder joint followed by inability to move the upper limb. This is associated with pain which becomes worse with attempted movements.
The common scenario is a patient supporting his affected upper limb by the other hand.
Early of a shoulder dislocation is of paramount importance. If a shoulder dislocation is neglected, it may lose its vascularity and become necrotic.
Careful clinical assessment is required to confirm the type of dislocation.
The mechanism of reduction is to reverse the order of the deforming force.
In 90 percent of cases, a shoulder dislocation may be reduced without requiring any form of anesthesia. In some cases, a mild sedative helps reduce the patient's apprehension. Rarely an open reduction is required and particularly in patients presenting late to the clinic.
Patient's co-operation is of utmost importance.
Every shoulder dislocation has a risk of re-dislocation with similar or less severe impact. This happens due to laxity of tissue surrounding the shoulder joint.
After a dislocation has been reduced, the patient must be forewarned about this complication.
The risk of re-dislocation may be substantially reduced with supervised physiotherapy and avoidance of the precipitating forces.
In a fresh dislocation occurring in a young patient; after performing a closed reduction, the shoulder joint should be splinted for a period of 2-3 weeks. In elderly patients, early passive exercises are allowed for fear of causing stiffness of immobilization.
A patient with history of shoulder dislocation should be kept under close observation.
If there are lesions in the glenoid labrum (bankart's lesions) or the Humeral head (Hill Sach's and Reverse Hill Sach's lesions), sometimes an operative intervention may be required in patients presenting with recurrent dislocations or shoulder instability that interferes with daily routine activities.
The risk of dislocation reduces with increasing age.

Shoulder Injuries and Disorders- Frozen Shoulder

Frozen shoulder or the technical name Adhesive Capsulitis of Shoulder, mostly seen in middle aged women and diabetics, causes global loss of shoulder movements in all directions.
Usually a self limiting disease, but the prolonged disease course causes much disability.
Early cases should be managed by a course of physiotherapy.
In non- responding patients, manipulation under anesthesia after injecting and inflating the shoulder joint capsule with saline is an alternative.
Prolonged supervised physiotherapy is almost always necessary.

Shoulder Injuries and Disorders- Impingement Syndrome

Shoulder impingement syndrome causes limitation of shoulder movements in one or more directions, but never complete global loss of movements.
Also known as a "Painful arc syndrome"; when the arm is taken overhead in the window cleaning position, patient catches pain. Pain is reproduced on every attempt to do this manoeuvre.
The patholy lies in the reduction of space for the free excursion of the rotator cuff tendons mainly Supraspinatus, beneath the acromion process.
This may occur due to inflammation of tendon itself, due to thickening of acromion process of shoulder blade (scapula); or due to repetitive stress injuries of the rotator cuff.
Treatment of this disorder is mostly conservative.
Most patients respond to suitable modification of activity or local steroid infiltration.
In patients who are resistant to conservative trials, decompression of the sub-acromial space may be performed surgically (Acromioplasty).

Shoulder Injuries & Disorders : Acromioclavicular Joint Injuries

AC Joint injuries are common due to fall on out-stretched hand. They have significant impact in overhead activities and sports.
Patients with AC joint injuries have been classified into six types, with severity ranging from simple sprain to complete destruction of all supporting ligaments and marked displacement of the collar bone from its normal position.
Not all patients with AC joint injury need surgery.
Most patients wherein the AC joint remains even in partial contact may be managed by a sling support. For more severe injuries, a reconstruction of ligaments may be taken immediately after the injury or at a later date.