SUPERIOR GLENOHUMERAL DISLOCATION

SUPERIOR GLENOHUMERAL DISLOCATION

· This very rare injury is less common than inferior glenohumeral dislocation.

Mechanism of Injury

· Extreme anterior and superior directed force applied to the adducted upper extremity, such as a fall from a height onto the upper extremity, forces the humeral head superiorly from the glenoid fossa.

· It is associated with fractures of the acromion, clavicle, coracoid, and humeral tuberosities, as well as injury to the acromioclavicular joint.

· Typically, it is accompanied by soft tissue injury to the rotator cuff, glenohumeral capsule, biceps tendon, and surrounding musculature.

Clinical Evaluation

· The patient typically presents with a foreshortened upper extremity held in adduction.

· Clinical examination typically reveals a palpable humeral head above the level of the acromion.

· Neurovascular injuries are common and must be ruled out.

Radiographic Evaluation

· Trauma series of the affected shoulder: AP, scapular-Y, and axillary views are obtained.

· The AP radiograph is typically diagnostic, with dislocation of the humeral head superior to the

acromion process.

· The radiograph must be carefully scrutinized for associated fractures, which are common and may be clinically not detected because of a diffusely painful shoulder.

Treatment

· Closed reduction should be attempted with the use of analgesics and sedatives.

· Axial traction with countertraction may be applied in an inferior direction, with lateral traction applied to the upper arm to facilitate reduction.

· As with inferior dislocations, soft tissue injury and associated fractures are common; irreducible dislocations may require open reduction.

Complications

Neurovascular complications are usually present and typically represent traction injuries that resolve with reduction.