Pediatric emergency medicine trisk 3443 3443

Shoulder Dislocation
Goals of Treatment
Traumatic dislocations of the shoulder usually result from an indirect force,
which overcomes the supports provided by the muscles and ligaments. The initial
goal of treatment is to manage the pain and expedite reduction of the shoulder
dislocation after radiographs have been obtained. Postreduction radiographs
should be obtained to confirm relocation and evaluate for fractures after
reduction.
CLINICAL PEARLS AND PITFALLS
Complications of shoulder dislocation include fracture of the humeral
head (Hill–Sachs lesion), tearing of the anteroinferior glenoid labrum
with or without associated bony injury (Bankart lesion), and
neurovascular injuries (Fig. 111.11 ).
Due to its close association with the glenohumeral joint, the axillary
nerve may be injured with shoulder dislocation, resulting in motor and
sensory defects.
There is a high rate of recurrence or joint instability in young active
patients 14 years and older. Consequently, patients who plan to return
to competitive contact sports may be candidates for surgical
stabilization after a first-time instability event.
Recurrence rates are lower in patients with open relative to closed
proximal humeral physis at the time of primary dislocation.
Current Evidence
Anterior shoulder dislocation is the most common joint dislocation seen in the
pediatric ED, and accounts for greater than 90% of shoulder dislocations.
Shoulder dislocation is rare in infants and children aged less than 10 years, but
becomes increasingly common through adolescence following physeal closure. In
the skeletally immature child, fracture of the proximal humerus is more common
than dislocation due to the anatomy of the physis. Shoulder dislocations are
associated with a 70% to 90% recurrence rate.
Intravenous sedation and analgesia has been the mainstay of pain control for

shoulder reduction when indicated; however, adult literature supports the use of
intra-articular injection of lidocaine as adjunctive or alternative approach to pain
control. Although no studies in strictly pediatric populations exist, consideration