Review Question - QID 26

Further radiographic studies are required including an axillary view. The humeral head resembles a "light bulb", indicating a possible posterior shoulder dislocation. Illustration A is an axillary view of this patient confirming chronic two-part fracture-dislocation of the anatomical neck of the humerus.

The Level 4 study by Hawkins and Neer describe their experiences with 41 locked posterior dislocations of the shoulder with 50% having an associated fracture. Twenty of the dislocations were missed diagnoses by treating physicians and the average time from injury to diagnosis was 1 year. Hawkins and Neer conclude treatment is determined by the duration of time the shoulder has been dislocated and the size of the humeral head defect, (reverse Hill-Sachs lesion).If the dislocation is less than 6 weeks old AND the defect involves less than 20% of the articular surface, then closed reduction should be attempted. If the dislocation is 6 weeks to 6 months old AND the defect involves 20 to 45% of the articular surface, transfer of the lesser tuberosity (McLaughlin procedure) should be done. If the glenoid is normal and the dislocation is more than 6 months old OR the defect involves more than 45% of the articular surface, or both, a hemiarthroplasty should be done. A hemiarthroplasty is indicated as treatment in this patient's case after obtaining full radiographs. It should be noted that adhesive capsulitis (option 1) does cause pain and loss of range of motion, especially with external rotation.