Answer
1) Plain radiograph show
- subcoracoid position of the humeral head
- No associated glenohumeral fracture (glenoid fossa of the scapula and the head of the humerus)
2) View
- Scapular Y view
- Axillary view
3) Right anterior shoulder dislocation
4) Mechanism of injury
- abduction, extension, and external rotation of the shoulder joint (preparing for volleyball spike)
- Fall on outstretched arm
5) Physical examination
- Axillary nerve (pin prick sensation of the deltoid muscle and palpable contraction of deltoid muscle on attempted abduction.
- Sensory and motor function of musculoskeletal and radial nerve
- axillary artery (palpate for the radial pulse)
6) Complication of the anterior shoulder dislocation
- circumflex axillary nerve damage (low/infraclavicular brachial plexus injury)
- Axillary artery damage
-Irreducibility
- Joint stiffness
- Recurrent dislocation
7) Management for this patient
-Do not reduce the dislocation without prior radiological assesment as it may worsened the condition if there is associated fracture
- Plain radiograph of the (AP Chest, Shoulder joint; Scapular Y view or axilary view)
- Examine the axillary nerve, musculoskeletal nerve, radial nerve and radial pulse
- Pain management (IV opiod)
- Manipulation of dislocation under general anesthesia
-Immobilize the shoulder by brought the arm across the body and bandaged it for three week.
- Discharge the patient with tab analgesic and ask to come again for review within 3 weeks time. Remind the patient on the importance of immobilization to prevent recurrent dislocation.
1) Plain radiograph show
- subcoracoid position of the humeral head
- No associated glenohumeral fracture (glenoid fossa of the scapula and the head of the humerus)
2) View
- Scapular Y view
- Axillary view
3) Right anterior shoulder dislocation
4) Mechanism of injury
- abduction, extension, and external rotation of the shoulder joint (preparing for volleyball spike)
- Fall on outstretched arm
5) Physical examination
- Axillary nerve (pin prick sensation of the deltoid muscle and palpable contraction of deltoid muscle on attempted abduction.
- Sensory and motor function of musculoskeletal and radial nerve
- axillary artery (palpate for the radial pulse)
6) Complication of the anterior shoulder dislocation
- circumflex axillary nerve damage (low/infraclavicular brachial plexus injury)
- Axillary artery damage
-Irreducibility
- Joint stiffness
- Recurrent dislocation
7) Management for this patient
-Do not reduce the dislocation without prior radiological assesment as it may worsened the condition if there is associated fracture
- Plain radiograph of the (AP Chest, Shoulder joint; Scapular Y view or axilary view)
- Examine the axillary nerve, musculoskeletal nerve, radial nerve and radial pulse
- Pain management (IV opiod)
- Manipulation of dislocation under general anesthesia
-Immobilize the shoulder by brought the arm across the body and bandaged it for three week.
- Discharge the patient with tab analgesic and ask to come again for review within 3 weeks time. Remind the patient on the importance of immobilization to prevent recurrent dislocation.