A 27 year old male presents for a right shoulder injury. He was attempting to break up a fight between his dogs when his right arm was pulled and he felt a “pop” in his right shoulder. He has been unable to move his right shoulder since and there is severe pain that is worse with movement. His vitals are within normal limits. On exam, the right upper extremity is neurovascularly intact. There is an obvious deformity of the right shoulder with severely reduced range of motion. An x-ray is performed and shown below. What’s the diagnosis?
Answer: Anterior shoulder dislocation
- Anterior dislocations of the shoulder are the most common type, approximating 99%. The mechanism typically occurs from forced abduction and external rotation.
- Exam will show a “squared off” appearance of the normal round contour of the shoulder and guarding of the arm in slight abduction and external rotation. The axillary nerve, which provides sensation to the proximal arm and shoulder, is most commonly injured.
- Diagnosis is obtained with plain radiographs. A scapular “Y” view shown on the right can help confirm anterior vs posterior in unclear cases.
- Treatment of simple cases involves closed reduction in the ED. There are various methods which can be achieved with or without sedation.
- Examples that do not require sedation: Cunningham, Davos, Fares,
- Examples that typically require sedation: Kocher, Traction-Countertraction
- Complications include recurrent dislocations (most common) and bony injuries such as Hill-Sachs and Bankart lesions.
References:
Bjoernsen L, Ebinger A. Shoulder and Humerus Injuries. In: Tintinalli JE, Ma O, Yealy DM, Meckler GD, Stapczynski J, Cline DM, Thomas SH. eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 9e. McGraw-Hill Education; 2020.
