A.R.A.R.A.I. PRACTICAL GUIDE FOR MANAGEMENT OF GLENOHUMERAL DISLOCATION IN EMERGENCY

Abstract

The shoulder joint complex is made up of five joints. Three of them are true: glenohumeral (GH), acromioclavicular (AC) and sternoclavicular (SC) and two are false: scapulothoracic (ST) and subacromial (SA). It is the joint with the highest Range of Motion (ROM) in the body and the most prone to instability, occupying 45% of all dislocations, 95% of which correspond to the anteroinferior dislocation. We present the acronym A.R.A.R.A.I., which details the initials of the scheme ordered to follow in a shoulder trauma with GH dislocation.

A (Axillary nerve anesthesia): includes the neurological and vascular evaluation, the most important of all, even before radiography and reduction.

R (Radiography): it is not possible to proceed to the reduction of a glenohumeral dislocation without first having an X-ray that rules out a fracture, if a reduction is carried out without an X-ray and a fracture occurs in the post-reduction control, the maneuver of reduction is the cause of the fracture so, to avoid legal problems, always request an X-ray before a reduction.

A (Anesthesia): every patient must undergo a reduction under anesthesia, especially if the patient is cared for in a hospital where there is an anesthesiology service.

R (Reduction): different reduction methods or techniques are used, we recommend that the doctor perform the maneuver with which he has the greatest affinity, some techniques are described.

A (Post-reduction axillary X-ray): One of the major complications in a (GHD) is the undiagnosed fracture of the anterior edge of the glenoid, so for us the Post-reduction axillary X-ray, especially in a patient’s first dislocations, allows us to diagnose an osseous Bankart (Bony Bankart) and treat it from the first episode to avoid resorption of the fractured fragment.

I (Immobilization in neutral): it is important the immobilization time that we recommend is twenty-one days and a neutral position to reduce the percentage of relapse.

The importance of this guide is for the appropriate clinical assessment, neurovascular, radiological assessment, and timely diagnosis of concomitant pathologies.