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Dislocated joint

Clinical Discipline(s)/Organ System(s)
Emergency Medicine, Musculoskeletal System, Orthopaedics
Progress Test Topic(s)
Musculoskeletal
Description
A 23 year old Samoan man attends the Emergency Department after dislocating his shoulder playing rugby. His friend who is a doctor has tried unsuccessfully to relocate the shoulder. The emergency nurse practitioner is managing the case and you are helping them.
Applied Science for Medicine 
   - Anatomy of the upper limb, including nerve and vascular structures at risk
   - Function of the rotator cuff
   - Aetiology of shoulder dislocations
   - Bankart and Hill-Sachs lesions
   - Pharmacology of paracetamol, non-steroidal anti-inflammatory drugs, codeine, tramadol, pethidine, benzodiazepines, midazolam and fentanyl
Clinical and Communication Skills 
   - History from a patient with acute limb injury
   - Examine the limbs, test rotator cuff function and recognise a dislocated joint
   - Differential diagnosis of shoulder dislocation
   - Interpret shoulder X-ray
   - Indications for CT shoulder, MRI shoulder, arthroscopy
   - Management of anterior, posterior and inferior dislocation of the shoulder
   - Complications of shoulder dislocation
   - Methods for preventing further dislocation
   - Prognosis of shoulder dislocation
   - Role of the emergency nurse practitioner, physiotherapist
Personal and Professional Skills 
   - Treatment of self and personal contacts
   - Patient education
   - Role of the Accident Compensation Corporation
Hauora Māori 
   - Differential ACC claims and rehabilitation for Māori vs non-Māori (for injuries in general)
   - Differential impact on employment/income for Māori
Population Health 
   - Epidemiology of shoulder dislocation
   - Epidemiology of injuries for the major sports in New Zealand
Conditions to be considered relating to this scenario
Common
anterior shoulder dislocation / instability
Less common but 'important not to miss'
axillary artery / nerve injury, brachial plexus injury, post-ictal dislocation, post-electrocution dislocation
Uncommon
posterior shoulder instability / dislocation