[##]-year-old [male/female] with history and exam consistent with [right/left
anterior/posterior/inferior] shoulder dislocation.
Initial consideration in this patient included shoulder dislocation,
fractures of the humerus, clavicle and scapula, acromioclavicular (AC) injury
or separation, rotator cuff injury or tear, biceps tendon rupture, and septic
joint among others.
Patient presented with [right/left] pain and evidence of the affected
arm in [abduction with ‘squared off’ appearance/adduction with prominence of
the posterior shoulder and flattened appearance of the anterior shoulder/full abduction
with hand on/behind the head] consistent with likely
[anterior/posterior/inferior] glenohumeral joint dislocation. Patient reported [unknown injury/brief
description of injury] that occurred [## minutes/hours] prior to
presentation. Patient [reported/denied]
a history of prior shoulder dislocation in the [same/opposite] arm. Plain films obtained with confirmation of
shoulder dislocation [with/without] clear evidence of associated fracture. We discussed [moderate sedation/intra-articular
anesthetic (lidocaine)] to facilitate reduction of shoulder dislocation with
the patient who provided [verbal/verbal and written] consent after discussion
of risks, benefits, and alternatives. A
complete neurologic and vascular exam of the [right/left] arm was performed
prior to attempted reduction and was [noted to be normal/notable for findings
consistent with axillary nerve injury]. Successful
reduction accomplished with [anterior dislocation: Cunningham technique
(physician massages the patient’s biceps muscle as the patient holds the arm
adducted and elbow flexed as the patient gradually shrugs shoulder)/Stimson
maneuver (patient prone on table with affected limb hanging freely over edge
with 10-15 lb weight suspended from wrist for 20-25 minutes)/scapular
manipulation (scapula manipulated in counterclockwise direction-stabilized
superiorly with medial force applied on the inferior angle)/traction-countertraction
technique (gradual, smooth traction applied to the affected arm until patient’s
muscled relax or tire sufficiently to release the dislocated humeral head while
assistant maintains countertraction to maintain patient in place)/Milch
maneuver (patient supine with steady downward traction applied at the elbow
combined with slow, gradual external rotation and abduction of the limb)] in
the ED.
Repeat plain films obtained after successful reduction of [right/left anterior/posterior/inferior]
shoulder dislocation with evidence of normal joint alignment [and evidence of Hill
Sachs lesion (impaction fracture of humeral head)/Bankart lesion (detachment of
anterior inferior labrum from glenoid)].
A complete neurologic and vascular exam of the [right/left] arm was
performed after successful reduction and was [noted to be normal/notable for
finding consistent with axillary nerve injury].
Patient was placed in a [sling/shoulder immobilizer] in the ED with
discussion of using immobilizer until cleared by Orthopedics.
Prior to discharge, we discussed return precautions, treatment with
[NSAIDs/analgesics], and follow up with primary care doctor within one week and
Orthopedics within 2-3 weeks for further evaluation, and the patient
demonstrated understanding and agreement with this plan.
Arthroscopic shoulder surgery in Mumbai also helps to repair any damage that the soft tissue might have sustained due to joint dislocation.
ReplyDeleteThe most ideal way to counter this is to fortify the back and shoulder muscles that hold your middle upright, instead of adjusted. You can begin at home with next to no loads or hardware with some neck-explicit activities.Relief Neck Pain
ReplyDelete