A 20-year-old male presents with anterior shoulder dislocation. This injury is usually caused as a combination of which of the following?

Ans. c. Abduction and external rotation (Ref: Maheshwari 3 ep74)Anterior shoulder dislocation is usually caused as a combination of abduction and external rotation.Mode of Injury Causing Shoulder DislocationRecurrent anterior dislocationPosterior dislocationInferior dislocationAbduction and external rotation forceIndirect force producing marked internal rotation and adductionSevere hyperabduction forceAnterior Dislocation of Shoulder* Shoulder is the MC joint to undergo recurrent and /or nonrecurrent (traumatic) dislocation0.* Anterior dislocation is the MC type of shoulder dislocation0 accounting for ~ 97% of cases.* Subcoracoid0 is the MC subty pe.Mechanism of Injury:* Two type of injury may lead to it:* External rotation or horizontal abduction force on humerus0 this movement occurs in throwing ball or slapping.* Direct posterior or posterioriaterai blow on shoulder, e.g. a fall on elbow directed backward and outward.* In young patients lesion of anterior capsule is most commonly an avulsion of labrum from front of glenoid and neck of scapula (Bankart's lesion).Anterior Dislocation of ShoulderPathology (in recurrent cases)* Bankart's lesion is stripping off fibrocartilage labrum from anterior glenoid and neck of scapula.* Hill Sachs lesion is compression fracture of posterolateral humeral head due to impression (friction) of glenoid rim. which occurs during repeated dislocation.Clinical Features:* Reproduction of patient's symptom in a position of abduction, external rotation and extension.* Patient keeps his arm slightly abducted hanging by the side of body.* Normal round contour of shoulder is lost and it becomes fiat.* Fullness /bulge is seen below the clavicleDugas test* It is not possible for the patient to bring the elbow close to the body and put the hand on his opposite shoulder0.Callaway's Test* In dislocation vertical circumference of axilla is increase compared to the normal side.Hamilton rulertest* Because of flattening of shoulder, it is possible to place a ruler on the lateral side of arm and it touches acromian and lateral condyle of humerus simultaneously (in normal it would not due to shoulder contour).* AP X-ray show overlapping shadow of humeral head and glenoid fossa: and later view show humeral head out of line with the socket.Management:* Commonly used reduction techniques are Stimson's gravity method, Hippocratic method and Kocher's methodsKocher's method* Reduction, in general (by Kocher's method) is done by increasing the deformity by traction and then doing opposite movements.* So the steps of reduction are traction in slight abduction and external rotation to increase deformity followed by adduction and internal rotation.Stimson's method* Patient is left prone with the arm hanging over the side of bed. Thus weight of limb helps in reduction.Hipprocatic method* In Hipprocatic method, gently increasing traction and counter traction is applied.