Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Posterior Shoulder Dislocation

SYMPTOMS

There is acute onset of localised swelling and pain over the posterior part of the shoulder, with typical deformation, after an excessive trauma. This injury is more common in epileptics and alcoholics than in athletes.

AETIOLOGY

This injury accounts for fewer than 5 per cent of shoulder dislocations. It is uncommon in sport but can occur from direct tackles or falls on an outstretched arm in rugby or American football.

CLINICAL FINDINGS

A first-time posterior dislocation in a young athlete will usually need to be repositioned under relaxation (by anaesthesia). It is often mistaken for the more common anterior dislocation. After repositioning, the posterior drawer test and the reposition test are positive.

INVESTIGATIONS

This is a difficult clinical diagnosis and is often missed. The active range of motion is grossly decreased. To find these rare cases of posterior dislocations, X-rays should be taken in different planes to rule out fracture and demonstrate the type of dislocation. MRI or CT are usually helpful for the diagnosis and to investigate associated injuries.

TREATMENT

Compared to anterior dislocations, this injury seldom requires stabilising surgery. If posterior instability causes discomfort it is felt during abduction and forward flexion. Physiotherapy is required to restore functional stability.

REFERRALS

Refer to Dr Kevin Yip (+65 9724 1219) senior consultant orthopaedic surgeon to determine the grade of the injury and for consideration of surgery. Refer to Dr Kevin Yip (+65 9724 1219) senior consultant orthopaedic surgeon to start a six-month rehabilitation programme.

EXERCISE PRESCRIPTION

Most sports and activities, such as cycling, cross-training and working-out, can be maintained but avoid further direct or indirect trauma to the shoulder. Running should be avoided since the shoulder will be sensitive to this type of impact and holding the arm still while running will cause secondary upper back and neck pain. Swimming should also wait for around three months. The specific rehabilitation should aim at a full range of controlled motion, good posture and thoracoscapular control by three months followed by functional training for up to four to six months before resuming sports like rugby.

EVALUATION OF TREATMENT OUTCOMES

Normal clinical symptoms and signs. The posterior drawer test should be negative. Functional strength, control and flexibility should be comparable with the other shoulder.

DIFFERENTIAL DIAGNOSES

Fractures must be ruled out. Multi-directional and general joint laxity is a complicating factor that needs to be addressed before any surgery.

 PROGNOSIS

Good-Fair depending on the severity.

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