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Key Features

  • Most dislocations (95%) are in the anterior direction

  • Dislocations usually are caused by a fall on an outstretched and abducted arm

  • Posterior dislocations are usually caused by

    • Falls from a height

    • Epileptic seizures

    • Electric shocks

  • Traumatic shoulder dislocation can lead to instability

  • Atraumatic shoulder dislocations are usually caused by

    • Intrinsic ligament laxity

    • Repetitive microtrauma leading to joint instability

Clinical Findings

  • Pain and apprehension with an unstable shoulder that is abducted and externally rotated

  • Acute traumatic dislocations

    • Acute pain and obvious deformity with the humeral head dislocated anteriorly

    • Patient holds the shoulder and arm in an externally rotated position

  • Patients with recurrent dislocations can have less pain with subsequent dislocations

  • Atraumatic shoulder instability

    • Usually well tolerated with activities of daily living

    • 'Sliding' sensation during exercises or strenuous activities such as throwing

    • May be less symptomatic

    • Can often undergo spontaneous reduction, with pain resolving within days after onset

  • See Table 41–1 for description of the apprehension test, the load and shift test, and O'Brien test

Table 41–1.Shoulder examination.

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