Shoulder Dislocation Ars.doc

Nama : Ni Luh Ayu Aris Ulan Devi NIM : 1802631051

SHOULDER DISLOCATION

Shoulder dislocation : Definition of dislocation in any joint, is that two articular surfaces which are normally in communication have become completely separated. Dislocation is the discharge (divorce) of the head of the joint from the bowl. If only partially shifted is called subluxation and if all is called a dislocation.Shoulder dislocation is a common injury. In around 90% of cases the shoulder dislocates anteriorly. This is generally caused by a fall on the hand but is occasionally due to direct trauma. Etiology : The shoulder joint is the most regularly dislocated joint in the body. The shoulder can dislocate forward, backward, or downward, and completely or partially, though most occur anteriorly. Fibrous tissue that joins the bones can be stretched or torn, complicating a dislocation. It takes a strong force, such as a blow to the shoulder to pull the bones out of place. Extreme rotation can pop the shoulder out of its socket. Contact sports injuries often cause a dislocated shoulder. Trauma from motor vehicle accidents and falls are also a common source of dislocation. Pathophysiology : Anterior dislocation is the most common, accounting for up to 97% of all shoulder dislocations. Mechanism of injury is usually a blow to an abducted, externally rotated and extended extremity. It may also occur with posterior humerus force or fall on an outstretched arm. On exam, the arm is usually abducted and externally rotated, and the acromion appears prominent. There are associated injuries in up 40% of anterior dislocations including nerve damage, or tears and fractures associated with the labrum, glenoid fossa, and/or humeral head.

IDENTITY COMPLAINT

NAME AGE ADDRESS OCCUPATION MAIN COMPLAINT (KU)

Mr. US 30 th. Ubud Waitrer in restaurant Instability and pain in the left shoulder

The patient felt pain and unable to move the left shoulder. The patient falls while working to deliver food the previous day. Pain in high CURRENT itensity that felt by the patient and more MEDICAL HISTORY painful when trying to move the left (RPS) shoulder and pain release when patient is rest. She doesn’t feel nausea, numbness and tingling. PAST MEDICAL shoulder dislocation due to a car driving an HISTORY (RPD) accident three years ago and being taken to a hospital for repositioning.

FAMILY MEDICAL HISTORY COMORBIDITIES MEDICAL HISTORY He works as a waiter at a restaurant in the SOCIAL MEDICAL Ubud area and he job duties in 8 hours a day HISTORY and almost all the time doing work by going around carrying food. RESP. RATE 20x/minute HEART RATE 85x/minute GENERAL BLOOD PRESSURE 120/80 mmHg EXAMINATION SPO2 99% CONCIOUSNESS E4V5M6 (Compos Mentis) - A bulge is visible anteriorly in thinner patients caused by the humeral head - The patient looks pain-free STATIC - Arm held in an abducted and exnternal rotation INSPECTION position - Loss of normal contour of the deltoid and acromion prominent anteriorly and medially DYNAMIC Range of motion is diminished and painful - Tenderness (+) - Humeral head palpable anteriorly - All movements limited and painful PALPATION - Palpable fullness below the coracoid process and towards the axilla - Feels warm on the left shoulder Regio Motion ROM Pain Flexion Limited + Extension Limited + Shoulder ACTIVE External rotation Limited + Dextra Internal rotation Limited + Abduction Limited + Adduction Limited + BASIC Regio Motion Endfeel Pain MOVMENT Flexion Firm + FUNCTION Extension Firm + PASSIVE Shoulder External rotation Firm + Dextra Internal rotation Firm + Abduction Firm + Adduction Firm + Patient unable to resist against minimal force RESISTED All movements limited and painful 1. Apprehension (crank) Test: + SPESIFIC EXAMINATION 2. Relocation test : + 3. Sensation test MEASUREMENT ROM S: 30° - 0 - 30° F: 20°-0-20° T: 10°-0-20° MMT 1111 5555

Pain (VAS)

5555 5555 Tenderness : 4/10 Motion pain : 8/10 Rest pain : 0/10

MEDICAL DIAGNOSIS S: - structure of shoulder region - joint of shoulder - muscle of shoulder IMPAIRMENT F: - pain in joint - mobility of joint functions - stabilty of joint functions PT DIAGNOSIS - muscle power function lifting and carrying object carrying, moving and handlling object ACTIVITY putting on clothes LIMITATION taking off clothes fine and use Work and employment PARTICIPATION community life RESTRICTION religion and spirituality Limitation of functional ability with pain and instability because of shoulder dislocation EVALUATION PLANNING Reduce pain SHORT TERM Increase ROM Increase mucle power PLANNING Return to normal activity as soon as possible without LONG TERM pain INTERVENTION 1. Repositioning/Reduction - External rotation, with patient in the supine position. Note the gentle traction (small arrow) and stabilization of the patient’s elbow in an adducted position while external rotation is applied by holding the patient’s wrist (large arrow) - While traction is maintained, the patient’s arm is slowly taken through a wide arc, from the patient’s side, into a fully overhead position. - Pull the arm straight overhead; then gently place it back into a neutral position over the patient’s abdomen and examine the shoulder for a successful reduction. 2. Immbilization Immobilization with the shoulder in a comfortable position of internal rotation, using a shoulder sling and swathe, has been recommended for 3 weeks post reduction for most patients. However, it is unclear whether 3 weeks is superior to 1 week with respect to the rate of recurrent dislocation. Shoulder is immobilized using a sling in 10 degrees of external rotation. During the immobilization period, the focus is on AROM of the elbow, wrist and hand and reduction of pain. Isometrics can be incorporated for the rotator cuff and biceps musculature. 3. AAROM to achieve full range of motion The patient sits relaxed and assisted while moving the shoulder to flexion, extension,

abduction, adduction, internal rotation and external rotation 4. Stretching Stretching in particular posterior shoulder structures, pectoralis major and minor and any other muscles with flexibility impairments 1. Avoid excessive movement of the shoulder 2. Avoid lying down on the soulder EDUCATION 3. Avoid lifting weights on the shoulder 4. Avoid movement increases pain 1. Strengthening Exercise Regular strengthening exercises once per two days without any joint movements for the rotator cuff muscles group (Resisted exercise) HOME 2. Stretching PROGRAM Regular stretching of the pectoralis major and minor and any other muscles with flexibility impairments is carried out after working for where each stretch is held for 10-15 seconds, repeated every 2-3 times - Pain is reduce : Tenderness : 3/10 Motion pain : 2/10 EVALUATION Rest pain : 0/10 - Range of Motion is increase - Muscle power is increse