Locked Glenohumeral Dislocation



A GH dislocation which has been missed for a significant period of time

- time period is arbitary

- > 3-6 weeks




Humerus soft and osteoporotic

Significant soft tissue contractures


1.  Anterior / subcoracoid dislocation



- scarring to NV structures

- RC tears including SSC, especially > 40

Anterior Instability



Traumatic initial cause in 95%


M:F 2:1


Age of initial dislocation inversely related to recurrence rate

- patients younger than 20 have a redislocation rate of 90%

- between 20 - 40 years, redislocation rate of 60%

- patients > 40 years have a 10% rate of dislocation but a higher rate of cuff tears (up to 40% in patients > 60yrs)


Anatomy & Stability


1. Passive Stabilisers


Frozen Shoulder



Idiopathic inflammatory condition

- characterised by progressive shoulder pain & stiffness

- due to contracture of capsuloligamentous structures

- spontaneously resolves 




2% incidence

- 40 - 60 years

- Women 2:1


Sedentary workers

- Non-dominant limb


Bilateral in 10 - 40%




Avascular necrosis

Shoulder AVN




Much less common than hip OA

- usually presents late




Similar causes as hip (AS IT GRIPS 3C)


Alcohol / Steroid / Trauma / Idiopathic




RA / RTx


Sickle Cell 




1.  Lateral decubitus

- stabilise patient with beanbag or lateral rests

- apply skin traction to forearm

- place traction pole at foot of table opposite surgeon

- suspend arm with 10 lb weight

- abduction 60°

- forward flexion of 20°

- tilt top shoulder posteriorly 30° so that glenoid is parallel wwith bed

- mark bony landmark

- prep & free drape





Indications have narrowed

- due to success of shoulder arthroplasty


1. Chronic infections of GHJ

2. Stabilization in paralytic disorders

3. Post-traumatic brachial plexus palsy

4. Salvage of failed GHJ Arthroplasty

- may need bone graft procedures

5. Arthritic diseases unsuitable for arthroplasty / young patient

Upper Limb Amputations

General Principles


All possible length should be preserved consistent with clinical judgement

- function of amputated stumps decrease progressively with each higher level of amputation 

- prosthetic rejection by patient increases with the more proximal amputations

- most ADL'S can be performed adequately with one limb, so don't use prosthesis

- all nerves are drawn distally into wound & sectioned so they retract well proximally to bone level of amputation