Although inferior dislocation is a rare injury, it is one that will be seen in a busy emergency practice. It is always a severe injury and is associated with significant soft-tissue trauma or fracture. The mechanism of injury is a hyperabduction force, which levers the neck of the humerus against the acromion. As the force continues the inferior capsule tears, and the humeral head is forced out inferiorly.
FIG. 263-8. Scapular manipulation technique.
The patient is in severe pain. The humerus is fully abducted, the elbow is flexed, and the patient's hand is on or behind the head. The humeral head can be palpated on the lateral chest wall. This clinical presentation is difficult to mistake for another condition.
Reduction consists of traction in an upward and outward direction in line with the humerus ( Fig 2.6.3.-9). The assistant applies countertraction. Reduction is signaled by a "clunk." The arm is then brought to the patient's side and immobilized in a shoulder immobilizer.
Complications include severe soft-tissue injuries and fractures of the proximal humerus. The rotator cuff, which is always detached, requires orthopedic follow-up. Neurovascular compression injuries are usually found but almost always resolve following reduction. When the humeral head is buttonholed through the inferior capsule, the dislocation is irreducible, and operative reduction is required.
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