Dislocatios ccrmc home位错 ccrmc回家.ppt

Dislocations Out of Joint In The ED Overview Joint dislocations require prompt and effective care in the Emergency Department Objectives: Discuss several techniques for shoulder reductions Discuss Hip dislocations/reduction Management and complications of knee dislocation Elbow dislocations and techniques for reduction Patellar dislocation Shoulder Dislocations 50% percent of all major joint dislocations Anterior most common 95-97% Posterior 2-4% Inferior ( luxatio erecta-which means “ to place upward”) Anatomy: shoulder is an inherently unstable joint. Glenoid is shallow-allows for wide range of movement Labrum fibrocartilaginous structure surrounds glenoid inserts into edge of joint capsule Inferoglenohumeral ligament :anterior/inferior portion of the capsule..thicker than the others and provides strongest support against dislocation Rotator cuff muscles provide additional support: subscapularis lies anterior supraspinatus/infraspinatus/Teres minor (SITS) lie posterior “pull” humeral head into glenoid Axillary nerve most commonly injured nerve in shoulder dislocations Runs inferior to humeral head. Innervates deltoid, teres minor—Shoulder badge” distribution Types of Shoulder dislocations Anterior- majority subglenoid 30% subcoracoid 70% Very rare infraclavicular Mechanism: usually caused by a blow or force to abducted externally rotated and extended arm… Think blocking a basketball shot Also fall on outstretched arm Mechanism of Dislocation Sports/ trauma ect Examination Anterior dislocation arm slightly abducted Externally rotated .Pt resists all movement. Loss of normal rounded appearance Typical apperance Arm abducted/ ext rotation Posterior Less common 3-5 % May be difficult to diagnose-may miss on up to 50% standard ap view as findings subtle Commonly assoc with greater tuberosity/surgical neck fx’s can cause a reverse h