Edited by Carew Giberson-Chen and Jeffrey “Spud” Olson - 7/1/2021
Descriptors
- Anterior vs posterior vs inferior
- With or without associated Bony Bankart or Hill-Sachs lesions
- With or without associated greater tuberosity or lesser tuberosity fractures
Exam Pearls
Upper extremity neurovascular exam
- “Flattened” shoulder with visible or palpable deformity
- Loss of both passive and active ROM
- Good assessment of brachial plexus and, specifically, axillary nerve function (transient axillary neuropraxia in ~5%)
Workup
Radiographs: 3 views of shoulder - true AP (Grashey), scapular Y, axillary. If unable to abduct arm for axillary view, obtain Velpeau view instead
Other imaging: CT shoulder if concern for fracture dislocation; outpatient MRI if age >60 (80% prevalence cuff tear)
Labs: None
Other: None
Management
Need for acute intervention: Closed reduction with sedation vs intraarticular block, followed by post-reduction XRs (views as above)
Note: if prosthetic shoulder dislocation, touch base with attending/fellow before attempting bedside reduction (risk of iatrogenic periprosthetic fracture)
Note: if posterior native shoulder dislocation appears engaged on glenoid, touch base with attending/fellow before attempting bedside reduction (risk of iatrogenic fracture)
Weight-bearing and range of motion: NWB in sling, encourage ROM of elbow, wrist, and fingers
Type of immobilization: Sling
Admission or discharge status: Discharge with 2 week f/u in sports clinic
Anticoagulation: None
Antibiotics: None
Surgical Indications
Absolute:
Open fracture-dislocations
Failed closed reduction at bedside
Relative:
Fracture-dislocations that meet surgical criteria
Bony Bankart lesion
Hill-Sachs lesion
Acute traumatic rotator cuff tear
Not an indication:
Axillary nerve palsy (usually transient neuropraxia)