SHOULDER

DISLOCATION
Penyusun:
Stephanie Aurelia S
Latar belakang
◦ Glenoid socket  sempit
◦ Stabilitas sendi glenohumoral
dipertahankan oleh glenoid
labrum, ligamen, dan otot di
sekitarnya.
◦ Stabilitas terganggu 
dislokasi (+)
Klasifikasi Patogenesis
◦ Alasan instabilitas bahu ada 2:
◦ Perubahan struktural  trauma
◦ Kelemahan otot Caput humerus lepas dari glenoid
◦ Tipe berdasarkan klinis dan terapeutik
◦
TRAUMATIC ANTERIOR INSTABILITY– POLAR TYPE I
• Karena proses akut  trauma
• Lengan atas  “dipaksa” melakukan abduksi,
rotasi eksternal, dan ekstensi
• Labrum dan kapsul terlepas dari anterior rim of
the glenoid (Bankart lesion)

Gejala klinis:
• Dewasa muda  “coming out”
shoulder
• Dx klinis:
• apprehension test
• Fulcrum test
• drawer test  cek instabilitas

Diagnosis:
• Foto X-ray AP/ axillary view
• MRI  cek lesi tulang/labral tear
Terapi:
• Operatif
• Indikasi:
• frequent dislocation, especially if this is painful, and
recurrent subluxation
• Anatomis  repair the torn glenoid labrum and capsule
(Prosedur Brankart)
• Non-anatomis  limited role in the management of shoulder
instability
• Putti–Platt operation  pemendekan subscapularis
• Bristow–Laterjet operation  coracoid process with its
attached muscles is transposed to the front of the neck
of the scapula
Brankart
Operation
Non operative Management
◦ Reduksi tertutup  bergantung dari waktu, lama  otot spastik
◦ Sedasi dan analgesik (20 cc lidocaine 1% atau 4 mg/kgBB)
◦ Teknik reduksi:
◦ Hipocratic methoid
◦ Kocher method
◦ External rotation method  modifikasi Kocher’s
◦ Stimson technique
◦ Milch technique
◦ Scapular manipulation
◦ Spaso technique
◦ Traction/countertraction

◦ Terapi konservatif  diberikan sling selama 1-6 minggu

◦ Rehab  dimulai 1 minggu setelah imobilisasi (ROM exercise)
 Milch’s

Kochker’s
Hippocratic

Traction/countertraction

Stimson’s
 Scapular

Spaso
ATRAUMATIC OR MINIMALLY TRAUMATIC INSTABILITY –
POLAR TYPES II AND III and POSTERIOR DISLOCATION
◦ ATRAUMATIC STRUCTURAL INSTABILITY
◦ multidirectional instability  trauma repetitif terhadap jaringan lunak
◦ athletes, particularly swimmers and throwers
◦ instability due to overload and fatigue in the stabilizing muscles of the shoulder
◦ Terapi: rehabilitasi dan operatif
◦ Rehab: strengthening the muscles and restoring muscular coordination and control
◦ Operatif  fisioterapi gagal

◦ ATRAUMATIC NON-STRUCTURAL INSTABILITY (ALTERED MUSCLE

PATTERNING)
◦ Stabilitas  synchronized muscle contractions and relaxations during movement.
◦ Terapi: Fisioterapi  The aim is to regain normal neuromuscular control and patterning.
◦ Posterior Dislocation
◦ Jarang  muncul karena violent jerk pada posisi tidak biasa
◦ Epileptic fit
◦ Severe electric shock