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Chronic Glenohumeral Dislocation

From WikiSM

Other Names

  • Chronic Glenohumeral Dislocation
  • Chronic Shoulder Dislocation

Background

History

  • Unknown

Epidemiology

  • Unknown

Introduction

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Watch a case presentation of a chronic shoulder dislocation

General

  • Although the shoulder is the most commonly dislocated joint, chronic shoulder dislocations are very rare
    • The vast majority of shoulder dislocations are reduced emergently
  • The definition is controversial, however one commonly accepted definition is >3 weeks[1]
  • Management decision making is complex and there is no consensus agreement among Orthopedic surgeons
  • Patients tend to have poor outcomes in terms of restoration of function

Pathophysiology

  • Most frequently encountered in elderly patients
    • Senesecence and sacropenia can predispose the joint to dislocation
  • In younger patients, less commonly see with:
    • Alcohol use disorder
    • Trauma
    • Seizure disorder

Associated Conditions

Risk Factors

  • Age
  • Seizure Disorder
  • Alcohol use disorder

Differential Diagnosis

Differential Diagnosis of Shoulder Pain

Clinical Features

History

  • Patients typically know they are chronically dislocated
  • They will have chronic glenohumeral pain, worse with movement
  • Severely limited range of motion
  • Inability to use the shoulder for any purpose
  • Reduced ADLs, ability to work

Physical Exam: Physical Exam Shoulder

  • The anterior shoulder may look deformed
  • A squared off acromion may or may not be present
  • The patient will have limited range of motion at the shoulder
    • Range of motion should be preserved in the hand, wrist and elbow
  • Complete neurovascular exam should be performed and documented

Special Tests

  • Not applicable

Evaluation

PA radiograph of a chronic shoulder dislocation. Note the significant bone remodeling. The yellow arrow points to a bony Bankart lesion, the red arrow a Hill-sachs lesion.
Axial CT cut of a chronic shoulder dislocation. The Humerus is seen anterior to the glenoid (red arrow). There is bone remodeling and a large Hill-sachs lesion (yellow measurements)

Radiographs

  • Standard Radiographs Shoulder
    • Sufficient to make diagnosis
  • Findings
    • Chronic shoulder dislocation
    • Bankart and Hill-sachs lesions
    • Bone spurring
    • Bone remodeling

CT

  • Useful to better characterize bone
  • Can be used for surgical planning

MRI

  • The role of MRI is not well defined
  • It can be used to look for associated muscle and tendon injuries
  • Evaluate the brachial plexus if needed

Classification

  • Not applicable

Management

Nonoperative

  • Generally, chronic shoulder dislocations require surgical intervention
  • Non-surgical management should be limited to:
    • Patients who are very poor surgical candidates
    • Patients who cant participate in rehabilitation
    • Patients who are unlikely to benefit
  • Decision not to operate should be made with an Orthopedic surgeon

Operative

  • Decision making and management is a problem for both patient, physician
    • No consensus among orthopedic surgeons about optimal management
  • Indications
    • Majority of patients
  • Technique
    • Closed reduction
    • Open reduction and fixation with Kirschner wires
    • Bankart repair
    • Bristow-Laterjet procedure
    • Coracoid transfer
    • Bone grafting
    • Hemiarthroplasty
    • Reverse shoulder arthroplasty

Rehab and Return to Play

Rehabilitation

  • Needs to be updated
  • Should be tailored to surgical approach

Return to Play/ Work

  • No clear guidelines

Prognosis and Complications

Prognosis

  • Functional demands, outcome expectations and rehabilitation potential must be taken into account
  • The ability to restore stability and activity is variable, the failure rate is high[2]

Complications

  • Loss of function
  • Chronic Pain
  • Axillary Artery Injury
  • Axillary Nerve Injury

See Also

Internal

External

References

  1. ↑ Unreduced chronic dislocation of the humeral head with ipsilateral humeral shaft fracture: a case report. Micic ID, Mitkovic MB, Mladenovic DS. J Orthop Trauma. 2005;19:578–581.
  2. ↑ Matsoukis J, Tabib W, Guiffault P, et al. Primary unconstrained shoulder arthroplasty in patients with a fixed anterior glenohumeral dislocation. J Bone Joint Surg Am, 2006, 88: 547–552.
Created by:
John Kiel on 3 February 2024 20:58:54
Authors:
Last edited:
2 May 2025 01:56:31
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