CCONFERENCEBy .. THATCHAPORN

ORTHOPEDIC

C

ผปวยหญงไทย อาย 78 ป ภมลำาเนา อำาเภอสคว

จงหวดนครราชสมา

PATIENT PROFILE

C ยกแขนขวาไมได 6

ชวโมง

CHIEF COMPLAINT

C

6 ชวโมงกอนมาโรงพยาบาล ผ ปวยเดนสะดดกอหญาลม เอาไหล

ขวากระแทกพน ศรษะไมกระแทก พน หลงจากนนปวดไหลขวา ไมม

บาดแผล ไมมชา ยกแขนขวาไมไดจงมาโรงพยาบาล

PRESENT ILLNESS

C

* เปนโรคหลอดเลอดหวใจตบ เคยผาตดทำาBALLOON ไป 6 ปกอน (มยาละลายลมเลอดกนอย)*ไมมประวตแพยาแพอาหาร*ไมเคยไดรบเลอด*ไมเคยไหลหลดมากอน* ไมดมสรา ไมสบบหร

PAST HISTORY

C

PHYSICAL EXAMINATION

A can talk , c-spine not tenderB equal breath sound , no use accessory muscle , CCT -veC alert ,BP 128/75 mmHg PR 98/min full , PCT -veD E4V5M6 , pupil 3 mm RTLBE

C

PHYSICAL EXAMINATION

Mild tender , no swellingLimit ROMNo loss of sensationDeltoid can contractElbow and wrist can movenot tender at another areaDuga’s test +Ruler’s test +Palpable head of humerous

C

FILM

C

DIAGNOSIS

Left Anterior shoulder dislocation

C

MANAGEMENTMorphine 4 mg IV statValium 10 mg IV stat

Start reduction! >> Close reduction

C

REDUCTION-ZERO POSITION

C

REDUCTION-Traction - Countertraction

C

C

C

ANTERIOR SHOULDER

DISLOCATION

“Glenohumeral joint”

SHOULDER

-Bone : Humerus , scapula , clavicle-Ball & socket joint-labrum is piece of cartilage (between head of humerus and glenoid)

SHOULDER-Rotator cuff muscle :

supraspinatus muscleinfraspinatus musclesubscapularis muscleteres minor muscle

-Ligaments that help :coracohumeral ligamentglenohumeral ligament

SHOULDER-Rotator cuff muscle :

supraspinatus muscleinfraspinatus musclesubscapularis muscleteres minor muscle

-Ligaments that help :coracohumeral ligamentglenohumeral ligament

ANTERIOR SHOULDER DISLOCATION•Mechanism : - direct blow from posterior aspect of shoulder- abduction + external rotation + extension injury

- tear ligament around shoulder- Axillary nerve injury

Clinical feature-Pain-arm position : abduction & external rotation-adduction is restricted-lost of normal shoulder contour

Duga’s test +Ruler’s test +Palpable head of humerous

Imaging

AP view

Transcapular view

Imaging

AP view

Transcapular view

Treatment>> most CLOSE REDUCTION (under GA)-Hippocrates method

Treatment>> most CLOSE REDUCTION (under GA)-Hippocrates method-Zero position

Treatment>> most CLOSE REDUCTION (under GA)-Hippocrates method-Zero position-Traction - countertraction

Treatment>> most CLOSE REDUCTION (under GA)

-Hippocrates method-Zero position-Traction – countertraction

*after reduction-on interlocking sling 3 weeks-if age > 45 years .. On interlocking sling 1 week and early ROM exercise