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Related Experiment Videos

Shoulder dislocation after infraclavicular coracoid block.

Jaime Rodrguez1, Mara Bárcena, Julián Alvarez

  • 1Department of Anesthesia, Hospital Clinico Universitario de Santiago, Travesia da Choupana, S.N., Santiago de Compostela 15706, Spain. jaimerodriguezgarcia@nacom.es

Regional Anesthesia and Pain Medicine
|August 29, 2003
PubMed
Summary

A rare case of shoulder dislocation occurred after brachial plexus anesthesia. Careful patient positioning is crucial to prevent this complication, especially when shoulder muscle paralysis is present.

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Area of Science:

  • Anesthesiology
  • Orthopedic Surgery

Background:

  • Brachial plexus anesthesia, particularly the infraclavicular coracoid approach, is a common technique for hand surgery.
  • Potential complications, though rare, require careful consideration and management.

Observation:

  • A case of anterior shoulder dislocation (head of the humerus) occurred post-brachial plexus block in an obese patient.
  • The dislocation was likely multifactorial, involving unrecognized glenohumeral instability, iatrogenic muscle paralysis, and specific arm positioning.
  • The dislocation was identified intraoperatively and successfully reduced without complications.

Findings:

  • Brachial plexus anesthesia can lead to shoulder muscle paralysis, increasing the risk of joint instability.
  • Improper arm positioning during surgery can exacerbate the risk of dislocation in patients with weakened shoulder muscles.

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Implications:

  • Anesthesiologists and surgeons must exercise extreme caution with patient positioning following brachial plexus blocks that induce motor deficits.
  • Awareness of potential shoulder instability and meticulous positioning are essential to prevent iatrogenic shoulder dislocations.
  • This case highlights the importance of considering the interplay between anesthetic technique, patient factors, and surgical positioning.