The procedure is done under general anaesthesia in four stages:
- Traction: Traction on the arm is applied.
- Adduction: Adduction of the limb is done while traction is maintained.
- External rotation: The forearm is externally rotated.
- Internal rotation: The limb is then internally rotated, and the dislocation is reduced.
REDUCTION OF INFERIOR DISLOCATION
TECHNIQUE OF REDUCTION
This is done in two stages.
- Traction is an abduction. The affected limb is fully abducted, and traction is applied upward in the direction of the long axis of the trunk. Counter- traction is applied by the assistant. This brings the head of the humerus in position with the glenoid fossa.
- Gentle adduction of the limb is then done, and full reduction is obtained.
Check for nerve lesion. Once the patient recovers from the anaesthesia, examination is made for any nerve lesion. Circumflex nerve damage is the commonest condition seen after shoulder dislocation. Deltoid function is tested by asking the patient to abduct the shoulder. Abduction may be absent also in associated rupture of the supraspinatus muscle is intact and there is no impairment of sensation over the outer surface of the shoulder. Abduction splint is applied in circumflex nerve and supraspinatus muscle lesions.
X-ray check up: Post reduction x-ray must be taken in anteroposterior and lateral views.
Immobilization: This is to prevent recurrent dislocation, which is more common in young adults but rarely seen after the age of 50 years. In the younger group, the arm is immobilized in a triangular bandage for a period of 3 weeks. Patients with previous history of dislocation should have the arm bandaged by the side of the trunk in adduction and internal rotation. Exercise is started after the period of immobilization.
- Nerve Injury: Circumflex nerve injury has been described. Most lesions are due to neuroparaxia and improve slowly in abduction splint.
- Muscle Injury:
- Supraspinatus tear: The patient experiences pain and weakness during abduction movement of shoulder. Abduction splint is applied for 6 weeks.
- Biceps tendon: Dislocation of the biceps tendon from the bicipital groove may interfere with the process of reduction. Operative measure may be required in this condition.
- Recurrent Dislocation: Recurrent dislocation may be disabling and will need surgical repair in the future.
- Bony Injury:
- Fractures of the greater tuberosity: The fracture segment comes into normal position once the dislocation is reduced.
- Fracture of the neck of humerus along with dislocation-
This should be reduced by a closed method by the usual procedure. Failure to do this will require open reduction. In elderly patients, the operation may be deferred, and the primary aim will be to obtain the maximum mobility of the joint.
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