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Luxatio Erecta (Inferior Glenohumeral Joint Dislocation)

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Topic updated on 10/10/15 11:27am
Introduction
  • Term for inferior dislocation of the glenohumeral joint
  • Epidemiology
    • incidence
      • very rare, only 0.5% of all shoulder dislocations
  • Pathophysiology
    • pathoanatomy
      • commonly involves variable sized tearing of static glenohumeral ligaments
  • Associated conditions
    • neurovascular injury
      • has greatest incidence of neurovascular injury of all types of shoulder dislocations
Anatomy
  • Static glenohumeral ligaments
    • SGHL
      • restraint to inferior translation at 0° degrees of abduction (neutral rotation)
    • MGHL
      • resist anterior and posterior translation in the midrange of abduction (~45°) in ER
    • IGHL
      • posterior band IGHL
        • most important restraint to posterior subluxation at 90° flexion and IR
      • anterior band IGHL
        • primary restraint to anterior/inferior translation 90° abduction and maximum ER (late cocking phase of throwing)
      • superior band IGHL
        • most important static stabilizer about the joint
  • See complete Glenohumeral anatomy 
Presentation
  • Symptoms
    • shoulder pain
    • inability to move shoulder
    • neurovascular injury
  • Physical exam
    • presents with the arm overhead with shoulder in full abduction, and elbow in flexion
Imaging
  • Radiographs
    • recommended views
      • complete shoulder series
    • findings
      • inferior glenohumeral dislocation with arm fully abducted
  • MRI
    • indications
      • can be obtained after shoulder is relocated to assess shoulder injuries
    • findings
      • may show capsulolabral pathology
      • rotator cuff tears common
Treatment
  • Nonoperative
    • closed reduction and immobilization
      • indications
        • good response to non-operative treatment
        • inactive elderly patients
      • technique
        • initial reduction and immobilization
        • followed by ROM exercises
        • physical therapy focusing on rotator cuff strengthening
  • Operative
    • reconstruction with arthroscopic or open repair
      • indications
        • capsulolabral damage
        • rotator cuff tear
        • active younger patients
      • technique
        • repair vs reconstruction of shoulder pathology
Complications
  • Axillary nerve palsy
    • usually resolves with relocation of shoulder
  • Axillary artery thrombosis
    • may occur late
  • Rotator cuff tear
    • especially in older patients

 

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(OBQ09.252) A 35-year-old male injured his right shoulder while playing basketball. He presents emergently with significant pain and his shoulder abducted at 140 degree. He is unable to lower his arm. Radiographs will most likely show that his humeral head has dislocated in what direction? Topic Review Topic

1. Anterior
2. Posterior
3. Superior
4. Inferior
5. Lateral

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http://upload.orthobullets.com/cases/2396/e4649f34-943f-4688-baeb-06c852a5b326_7.jpg http://upload.orthobullets.com/cases/2396/f1e3faf5-2797-405f-aa6b-ec4d303cb806_4.jpg http://upload.orthobullets.com/cases/2396/49c4c2bc-b91b-453c-92f1-015d9fcc2eb7_3.jpg
HPI - Traumatic event causing dislocation right shoulder dislocation. The patient has...
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