Anterior shoulder dislocation

This is the most common type of dislocation of the shoulder - 95% are anterior (1). It accurate diagnosis requires 2 radiographs:

• an AP, with
• an axillary or transcapular view

The history is often one of a fall on the hand.

On examination, there is a flattening of the deltoid (giving rise to a positive Hamilton's ruler sign), with a bulge visible anteriorly in thinner patients. The axillary nerve supplies sensation over a small area on the lateral aspect of the shoulder (sergeant's stripes area) and this should be tested in any shoulder dislocation injury.

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.

Reference:

1. Phadke A, Bakti N, Bawale R, Singh B. Current concepts in management of ACJ injuries. J Clin Orthop Trauma. 2019 May-Jun;10(3):480-485.