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Upper limb dislocations (ACJ (Diagnosis (X-radiograph Graded 1-5…

- - - - Epidemiology
        Rare
      - Pathophysiology
        Epileptic seizure or electric shock
      - Clinical presentation
        Pain, instability
        Limited external rotation
      - Diagnosis
        
        Examination
        Shoulder
        C-spine
        Neurovascular
        
        X-radiograph
        Lightbulb sign
      - Management
        
        Refer to orthopods
    - - Clinical presentation
        Shoulder pain and instability
        Loss of shoulder contour
        Anterior bulge (humeral head)
      - Diagnosis
        
        Examination
        Shoulder - instability
        C-spine exam
        Neuovascular exam
        
        X-radiograph
        
        CT/MRI
        To see Bankhart/Hill-Sachs lesiosn
      - Pathophysiology
        Young athletes or elderly fall onto arm/shoulder
        If recurrent, capsular joint damage leads to instability
        May have Bankhart lesion (avulsion of humeral head from glenoid tears the glenoid labrum; bony and/or soft tissue damage)
        May have Hill Sachs lesion (impacted humeral head into glenoid)
      - Management
        
        Conservative
        Analgesia (LA, opioid, entonox)
        Reduction (simple or Koher's; X-ray post-reduction
        as risk of humeral fracture
        Sling support in internal rotation, PT
        
        Surgery
        If young/athletic/associated Bankhart lesion/capsular shift
        Hill-Sachs repair - replace humeral head with bone graft/metal prosthesis
      - Epidemiology
        Commonest type
    - - Epidemiology
        Rare!
      - Pathophysiology
        Hyperabduction
        Lots of complications - neurovascular involvement,
        tuberosity avulsion, rotator cuff tears
  - - - Conservative
        Rehabilitation (1L)
      - Surgery
        If no response to rehab
        Inferior capsular shift - stabilise inferior capsule to prevent dislocation of humeral head