of Acute Shoulder Dislocation Athletic Training 急性肩关节脱位运动训练管理课件.pptVIP

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of Acute Shoulder Dislocation Athletic Training 急性肩关节脱位运动训练管理课件.ppt

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of Acute Shoulder Dislocation Athletic Training 急性肩关节脱位运动训练管理课件

* Reduction Success: Stimson technique reduction in 14/16 w/ lido, 11/14 w/ IV Sed. All 5 that could not be reduced initially were reduced with scapular manipulation Reduction Time: 11.4 w/ Lidocaine, 8.5 w/ IV Sedation Pain Score: 7.0 +/- 2.6 w/ Lidocaine, 7.4 +/- 2.5 for IV Sedation ER time: 75 min +/- 48 minutes w/ Lido, 185 min +/- 26 min for IV Sed (p0.01) Other studies have shown incidence of respiratory depression with IV Sedation Use Cost: Lidocaine: $0.52, IV Sedation: $97.64 * Greater success with Milch’s technique in pts 40yo Greater success with Kocher approach, especially in people with a heavier build * Immobilization: Arm tied to torso (internal rotation) * ER: with wire-mesh splint, held arm in 10 D of ER IR: sling and swathe Compliance 40% for IR pts, 68% for ER pts Miller et al, Journal of Shoulder Elbow Surgery 2004, measured contact forces between the Bankart lesion and the glenoid in cadaveric shoulders. Showed that the greater the external rotation, the greater the amount of contact force. Itoi et al placed patient’s in 10 D of ER because of concerns of patient comfort with increased ER. * Questions yet to be answered: The best position for immobilization -- how much ER? 2. The optimum duration of immobilization has not bee determined. Management of Acute Shoulder Dislocation An overview Heather Campion Sports Medicine Conference 1/22/08 Incidence Shoulder is the most commonly dislocated joint Traumatic Dislocations Anterior 96% Posterior 2-4% Diverse group of patients experience dislocations; M and F young and old active and inactive Anatomic Consideration Glenohumeral stabilization mechanisms Passive: joint conformity, vacuum effect, ligamentous and capsular restraints, labrum Active: long head of Biceps and Rotator Cuff Pathoanatomy of shoulder dislocations Bankart Lesion: avulsion of anteroinferior labrum Hill-Sachs Lesion: posterolateral humeral head defect Assoc. RCT: more common in older patients Clinical Evaluation PE: