Superior Glenohumeral Dislocation: Diagnosis & Treatment Guide

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.