Management of Chronic Shoulder Dislocations
- Chronic dislocation of the shoulder should be suspected in patients with shoulder pain and decreased range of motion in the context of dementia, alcoholism, obesity, seizure disorders, or multiple trauma.
- A patient with a posterior dislocation is most comfortable in a standard sling and should be fully evaluated.
- A quality axillary lateral radiograph is necessary to rule out dislocation.
- Closed reduction of a chronic shoulder dislocation after 3 weeks can be very difficult, and open reduction should be considered.
- Extensive bone loss should be addressed to improve postoperative stability.
- Posterior dislocations result in anteromedial humeral head impaction injuries, and anterior dislocations can cause both posterolateral humeral impaction injuries and anteroinferior glenoid bone loss.
- Arthroplasty should be considered in patients with greater than 50% humeral head destruction, preexisting arthritis, and low functional status.
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