What is the difference in patient presentation in patients with anterior, posterior, or inferior glenohumeral dislocation?
Answer
Anterior dislocation is the most common, followed by posterior location and inferior dislocation.
Anterior Presentation:
The patient holds the injured arm supported at the side in slight abduction and slight external rotation.
There is an inability to move the arm due to intense pain, especially with adduction or internal rotation.
There is an obvious deformity of the shoulder, with loss of normal contour of the lateral shoulder and a prominent acromion. That deformity is palpated as a step deformity (a finger gap between your acromion and your head of the humerus).
Divided into four types: subcoracoid (most common of anterior dislocation), subglenoid, subclavicular, and intrathoracic (rare)
Posterior Patient Presentation:
The patient holds the arm at their side with the shoulder in internal rotation.
The inability to move the shoulder due to pain, specifically abduction and external rotation, and visible deformity, with prominent acromion and coracoid processes.
Fullness in the posterior axilla can be detected due to the displaced humeral head.
Inferior Patient Presentation:
The patient's arm is hyperabducted, with the elbow flexed and the hand in an overhead position.
Unable to lower the arm due to pain and locking.
The humeral head can often be palpated in the axilla.
For additional information on this topic, please check out the Glenohumeral Dislocation and Rehabilitation course by Rina Pandya, PT, DPT.
Rina Pandya, PT, DPT, PGCert LTHE, AFHEA
Dr. Rina Pandya, PT, DPT, has an extensive physical therapy career that spans over 20 years, through the UK, the USA, and the Middle East. She has worked in NHS (National Health Service), American health care providing PT services in acute care, in-patient rehab, skilled nursing facility, home healthcare, and outpatient clinic. In addition to being a clinician, she has developed specialty programs based on evidence-based practice in her role as a project manager. She has also managed a Physical Therapy department as Department Head in a premier private hospital in Oman. Currently, Dr. Rina is a senior lecturer of physiotherapy (musculoskeletal physiotherapy) at the University of West England, Bristol, UK, and an author of a pocket book series titled Orthopedic Assessments Made Easy.
Rina graduated from Manipal University, India, in 2000, as well as the University of Michigan, in 2018 with a Doctor of Physical Therapy. Rina has been awarded a postgraduate certificate in learning and teaching in higher education (PGCert LTHE) and is an associate fellow in higher education (AFHEA). She is also a member of the APTA, HCPC-UK, and OAP-Oman.
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