Professional Documents
Culture Documents
Presented by:
M. Rizqi Firyal
71 2016 048
+ 20% shoulder dislocations aged >60 y.o.
Recurrency
90% age of 20s & 30s
<10% age ≥ 40 y.o.
closely evaluate:
The greater tuberosity of the humerus
missed subtle fractures (overpenetrated
radiographs)
The goal of pysical examination:
Measure joint stability
Diagnose associated injuries
Inspection
+ Muscular atrophy chronic rotator cuff or
nerve palsy
Obvious deformity
+ Contour loss of coracoid anterior dislocation
+ Prominent coracoid + posterior dislocation
Examinate shoulder passive ROM crucial
Resisted
thumb down shoulder abduction in
the scapular plane + supraspinatus
pathology.
In older patients,
Degenerative cuff more likely to tear
Stronger capsular attachments
Dislocation + supraspinatus tear
Strong corelation 150 pts, age 40-60 y.o.
(underwent arthroscopy)
third
part of the axillary artery (segment
below the lower edge of the pectoralis minor
muscle) + 86% injury location
Mostly occur
chronic dislocated shoulders in older pts
after closed reduction
Hemiarthroplasty
significant improvement in flexion, abduction &
external rotation
noted ROM 37-month follow-up
Chronic dislocations
3-4 weeks post injury
+ closed reduction operating room under
complete muscular paralysis.
In one study,
88% uneventful closed reduction in the
emergency department
5% needed general anesthesia
3% required open reduction
Neurovascular examination
+ vascular surgery concultation
Week 3-4
passive pendulum and Codman exercises
add progressive passive and active ROM
(therapist supervision)
If fail + cuff weakness persist re-evaluate w/
MRI
However, if on initial presentation significant
cuff weakness exists, earlier imaging may be
indicated.
Older pts
More likely to sustain injuries, lesser compliance
(axillary nerve or brachial plexus)
Patients should be assessed for rotator cuff
tear.
Treatment
Focus on early closed reduction
Physical therapy
Goal: restoring motion and strength
Evidence-based Medicine: Levels of evidence
are:
Level III studies
Level IV studies
Level V expert opinion
Published within the past 5 years.