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So, hello everyone. Um Thank you for joining us today. My name's Luke. I'm with the education directors at SA. Um Can I just get someone from uh the audience? Just confirm that you can hear me and see me and everything sounds OK. And if you just a thumbs up on the chat or, or whatever, OK, guys, can you can you Yeah, perfect. OK, great. We'll make a start. So, um as I said, my name's Luke for the education director at SI PA. Um This week we're focusing on upper limb TN O. We're excited to have you all with us today. I'm joined by Amin Sohan. Um who will guide you through the clinical conditions of the upper limb. Um So, Amin is a final year medical student from the University of Central Lancashire to make decisions as engaging as possible. Um We'll be releasing polls throughout, so they're completely anonymous and we encourage you to participate actively. If you have any questions during the session, please pop them in the chat and we'll do our best to address them at the end of the session, we'll share a feedback form. Um And if you complete this. You'll receive a certificate of attendance and exclusive discount codes for teach me surgery and pass the MRC S. Additionally, this session is being recorded, the recording and slides will be shared on our meal page a couple of hours after the session. So be sure to keep an eye out for that. Um We're also excited to share that an exclusive question bank and other resources will be available on our learning portal. Um So be sure to check, check out our website to access them. If you create a free membership account with us, you'll automatically receive a discount code for 10% off the geeky medics, anatomy, flashcards, surgery, flash cards and knowledge bundle. We also have an exciting opportunity for all our attendees. So two lucky people will win free access to the GKI medics surgical flash cards and the geeky medics stations to enter simply complete the Google form at the end of the session and enter the unique code. We'll provide the more sessions you attend the higher your chances of winning. So be sure to stay to the end of today's session and attend as many of our other sessions as well. And just finally before we begin, we'd like to thank our partners which are the Royal College of Surgeons in England, EK Medics, the MDU more than skin deep metal, teach me surgery and pass the MRC S. Um So without further ado, I will pass over to a Thank you very much, Luke uh for the interruption. Um I'm just gonna share the slides. Uh Sorry guys, I don't have access to the chat, but if you have the questions, we'll be able to read it out loud later. So thank you again, everyone for joining. Uh, we're just focusing on off li conditions today. We're just gonna wheeze through uh a lot of the conditions. So it's gonna be a fast um paced session. And then if you have any questions again, pop in, in the chat, try to answer as best as we can to our partners. This is the learning objectives. So the first case, a 30 year old uh 32 year old male with a history of epilepsy presents to a knee after experiencing a generalized tonic clonic seizure, he complains of a severe right shoulder pain and he's holding his arm in a slight abduction and internal rotation examination reveals a loss of the normal shoulder contour with prominent acromion, there is a reduced range of motion and no obvious neurovascular compromise. So the question is, what is the most likely type of shoulder dislocation in this patient? A inferior b posterior and then c inferior think uh Luke is just gonna, oh he has already put the question. We're just gonna give it a few seconds if you could, if you guys, if you could participate, where you have like 10 responses so far, I mean, can you, can you see the results. Yes. Now, since it's 50 to 50 now, um the correct answer is posterior. Although um anterior dislocation are most common, 90% of them are uh 90% of shoulder dislocation tend to be anterior. However, with the history uh that uh patient is presenting with and the uh signs and symptoms described uh it's more likely to be a posterior. So we're just gonna go through um the X ray of anterior and what we find and uh basically what are the um things we should be looking for. So, in an anterior dislocation, uh well, we any dislocation, what we do is we get an x-ray initially. And then um we see if there is any neurovascular compromise, if there's any um fractures that we can see on x-ray or uh or uh neurovascular compromise on examination. Um If not, then we will proceed with um an attempt to put the shoulder back and then we will try to get another x-ray to confirm that uh we have restored a normal anatomical position. So, um on the left, we have anterior uh an x-ray of an anterior dislocation. As you can see, the humeral head is dis dislocated anteriorly and rests on carotid process. Uh Whereas on the uh posterior side, we got uh commonly known light bulb on a stick sign as I put light light bulb here as well. You can see that um the edges of the humeral head is sort of looking like a light bulb. Um And this is a sign of posterior dislocation. So the humeral head does not appear um uh sorry. Um It is internally rotated and the contour uh again, as I mentioned, it looks like a light bulb and that's why it's called a light bulb. So, so uh as I mentioned, 90% of the shoulder dislocations are anterior dislocations. And the position you would find the arm in is internally rotated and abducted and you might have a silhouette flattened. Uh you might have flatter silhouettes um with a prominent acromion and the 10% of them which are in anterior are usually posterior. Uh and where you find the arm is, uh the arm is fixed internally rotated and a do and this commonly happen in two situations. One of them being uh in people who have epilepsy. So when they have a fit, they sometimes uh tend to have to tend to get uh their arm dislocated. Now, many of them are able to just pop it back in. So they would, they would do that and they wouldn't have to come to the A&E but sometimes it's, it becomes really difficult for them to do that. They won't be able to put it back in and then they will come to uh A&E perhaps to get it checked and put it back in. And uh the other scenario where you get uh posterior dislocation is commonly known for is uh electrocution. So, uh again, a similar mechanism of procedure, um you often get a posterior dislocation and there is another type of dislocation with uh in which is an inferior dislocation uh where the arm is uh in abducted position. And sometimes it's the arm is held, evolve like that. Again, it's not as common as anterior posterior and the management with uh shoulder dislocations. Uh What we do is we try to give a good uh painkiller, make sure the patient is at ease as much as he can. And then uh you take a history, you find out what's been going on. Um You know, uh first time dislocations often result from high back injuries. Um but uh if they've already had many dislocations, they might have instability of the shoulder uh ligaments and that may put them at increased risk of uh having a shoulder dislocated again, I'm sorry, keep pushing it. So, back to the slide, uh on examination, you just have to check the neurovascular exam. So you do a neurovascular examination, you check for uh the nerves, make sure they have sensation if they can move the fingers distally. Um uh This is just to make sure that there is no nerve injury. Uh Axillary nerve, uh palsy may result from um sort of dislocation and you may get a numbness in the regimental badge area where you find the deltoid. So if there is a numbness over there, uh if you suspect Axillary nerve injury. Um And what you often find is that the patient is not able to demonstrate any external rotation in posterior dislocation. Uh So what you do is with the management, uh as I mentioned, you get an x-ray before reduction, minimum two views and then once you're uh happy that there is no uh injury to the nerves, there's no fractures. Uh you can attempt at uh relocating the joint and um again, you get an X ray to make sure everything is fine. Uh There are different techniques where you can uh reduce the shoulder. Um.