Muhamad Na'im B Ab Razak (jacknaim) is a fresh graduate Muslim Doctor from Universiti Sains Malaysia and waiting for the enrollment into the housemanship program. Ambitious in pursuing master program in emergency and traumatology medicine and loves to spent his free time joining humanitarian missions, writing and speaks as an amateur public speaker in motivation and comparative religion. [HOME]

60 Years old lady with painful right shoulder and reduce range of movement

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.