Hajer Ali Sarah Sameer

Stability of the shoulder joint The shallowness of the glenoid fossa of the scapula and the lack of support provided by weak ligaments make this joint an unstable structure. its strength almost entirely depends on the tone of the short muscles that bind the upper end of the humerus to the scapula – namely, the subscapularis in front, the supraspinatus above, and the infraspinatus and teres minor behind. The tendons of these muscles are fused to the underlying capsule of the shoulder joint. Together, these tendons form the rotator cuff. The least supported part of the joint lies in the inferior location, where it is unprotected by muscles.

Dislocations of the shoulder joint Anterior- inferior dislocations Sudden violence applied to the humerus with the joint fully abducted tilts the humeral head downward onto the inferior weak part of the capsule, which tears and the humeral head comes to lie inferior to the gleniod fossa. During this movement, the acromion has acted as fulcrum. The strong flexors and adductors of the shoulder joint now usually pull the humeral head forward and upward into the subcoracoid position.

Dislocation of the shoulder joint Posterior dislocations Posterior dislocation are rare and are usually caused by direct violence to the front of the joint. On inspection of the patient with shoulder dislocation the rounded appearance of the shoulder is seen to be lost because the greater tuberosity of the humerus is no longer bulging laterally beneath the deltoid muscle. A subgelniod displacement of the head of the humerus into the quadrangular space can cause damage to the axillary nerve, as indicated by paralysis deltoidand loss of skin sensation over the lower half of the deltiod. Downward displacement of the humerus can also stretch and damage the radial nerve.

Other types of dislocation subluxation is defined as a partial or incomplete dislocation that usually stems from changes in the mechanical integrity of the joint Fracture are broken bones. Fractures commonly involve the clavicle (collar bone), proximal humerus (top of the upper arm bone), and scapula (shoulder blade

A.Subluxation B.Partial dislocation C.Complete dislocation Subluxation (A) Partial dislocation (B) Complete dislocation ©

Treatment Physical Therapy In the acute phase of a dislocated shoulder, therapy should be limited. The arm should be immobilized in a sling and swathed for 1-3 weeks Surgical Intervention The recurrence rate for shoulder instability is highly dependent on the age of the patient. Nonoperative care should be performed first before entertaining the thought of surgery