RELOCATION OF PATELLA + SHOULDER

• In what way do patellas tend to dislocate?

  laterally (can be medial but very rare)
• Indications for a patella relocation

  • isolated patella dislocation
• what are the contraindications for a patella relocation?

  none
• what are the cautions for a patella relocation?

  • complicated by a fracture
  • significant trauma
  • dislocation involved with more than the patella
• what are the steps for the relocation of a patella?

  1. determine joint dislocation (confirm isolated dislocation, obtain vitals, limb baselines and history)
  2. explain procedure and gain consent
  3. administer pain relief
  4. reduce patella - 2 clinicians, bend the knee at a 45-degree angle, grasp the patella with one hand and push it medially whilst also straightening the knee.
  5. if successful there should be pain relief, normal knee shape, improved ROM
  6. document and decide on transport options
• what is the most common way for a shoulder to dislocate?

  anteriorly
• what are the indications for a shoulder relocation?

  • anterior dislocation
  • previous dislocation from that joint
  • no clear acromioclavicular joint dislocation
  • no clear evidence of a fracture of the humerus
  • dislocation is a result of mispositioning and/or minor force
• what are the contraindications for a shoulder relocation?

  • posterior dislocation
  • first-time dislocation
  • AC joint dislocation
  • fracture of humerus
  • major force as cause for dislocation
• are there any cautions for a shoulder relocation?

  no
• what are the steps of preparation?

  1. assess limb baselines
  2. determine whether it is appropriate to relocate
  3. explain the procedure and gain consent
  4. pain relief
• what pain relief is used for a patella dislocation?

  • IV
  • methoxyflurane if IV is not appropriate
  • call for back up if pain is significant
• what pain relief is used for a shoulder dislocation?

  • IV
  • methoxyflurane if IV is not appropriate
  • call for back up if significant pain
• what are the 2 types of relocation styles for a shoulder?

  • modified Kocher's technique
  • Stimson technique
• how to do Kocher's technique?

  1. position supine or sitting with arm by side
  2. bend elbow to 90 degrees
  3. apply traction to the humerus and slowly externally rotate the arm until resistance is felt (usually at 45 degrees)
  4. slowly abduct the arm
  5. massage the head of the humerus if the shoulder does not relocate.
• how to do the Stimson technique?

  1. place the patient prone on the stretcher with the arm hanging towards the ground (ensure it does not touch the ground)
  2. apply continuous downward traction on the hand or wrist for several minutes
  3. if the shoulder does not relocate, maintain traction and gently rotate the hand and wrist outwards and maintain this position for several minutes
  4. if the shoulder does not relocate, apply scapular rotation whilst maintaining downward traction on the arm
• what does an assessment of a successful shoulder relocation involve?

  • palpable or audible clunk
  • relief of pain
  • normal shaped shoulder
  • ROM
• what to do after a successful shoulder relocation?

  • reassess limb baselines
  • document