Anteroposterior view of shoulder revealing posterior dislocation
Posterior dislocation is rarer as compared to anterior dislocation. When it occurs damage to the structures is much more owing to the force required for disruption of the joint.
These patients present with pain and deformity. The patients have much more pain than those with acute traumatic anterior dislocations.
After the clinical examination and xrays the diagnosis can be reached at with certainty. A greater damage to the glenoid and humeral head may be evident on xrays.
Careful note is made of associated fractures, including the extent of the impression fracture of the anteromedial humeral head.
Closed reduction should be caried out as soon as possible.
Because of associated muscle spasms, the reduction may not be achievable with sedation and muscle relaxants.
Therefore it is better to reduce these dislocations in general anesthesia. Once the spasm has been tackled , the reduction is usually easy to accomplish.
Technique
The patient is placed supine and the traction is applied to the adducted arm in the line of the deformity. The head of humerus is gently lifted back into the glenoid fossa. The reduction is very easy if adequate muscle relaxation has been done. A counter traction is applied by an assistant in the lateral direction using a folded towel. The reduction can be facilitated by gently internally rotating the humerus.
Postreduction Care
Stability is checked after reduction. DIstal neural and vascular exmaination is done. If the reduction is stable immobilization in a sling-and-swath or arm chset bandage may be acceptable.
If the reduction is not stable and the head tends to dislocate, a shoulder spica should be used in most stable position.
To allow posterior capsular healing, the shoulder is best be immobilized with the arm in 30 to 40 degrees of external rotation t
I Have been diagnosed with posterior dislocation of my left shoulder. I have had surgery on the shoulder before for a labrium tear and decompresion. Now 8 years later this has happened and my doctor dont act as if he knows how to deal with it. he has even said that maybe I should go back to the doctor that did the first surgery.He requested a copy of the surgery notes and said he would review it and then let me know. He wants me to go to pysical therapy for thearaputic range of motion. It has now been three weeks since all this started. My soulder has been hurting for about 2 months and then i picked up something really heavy and my shoulder started to kill me. My muscles in my neck hurt all the way to the bicept muscle in my arm. I totally know what you all mean about muscle spasms. My queston is how long should I wait for this doctor to make up his mind. I want some relief. I can’t sleep at night because I can’t get comforatable and I can’t take flexeril I had and alergic reaction to it. What to do? I need to get better so I can go back to work. Melody
Dr Arun Pal Singh Reply:
March 25th, 2010 at 12:10 am
@Melody,
If this is first dislocation and was reduced, I think you need a reevaluation of what could be hurting.
Your neck should also be examined for any injury.