A middle aged man presented with a painful right shoulder after falling off his bike. Examination revealed loss of the normal shoulder contour and markedly restricted movement due to pain. After confirmation of the diagnosis a procedure was performed.
Images
Image 1: Transverse view of posterior right shoulder.
Video 1: Transverse view of posterior right shoulder during procedure.
Image 2: Transverse view of posterior left shoulder (uninjured) for comparison.
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1. Question
Question: What is the diagnosis?
Correct
CORRECT ANSWER EXPLAINED BELOW
Correct answer is: Glenohumeral joint dislocation
Discussion
The initial image shows the glenoid fossa is ‘empty’ with the humeral head displaced away from the transducer, diagnostic of an anterior glenohumeral joint dislocation. The video demonstrates the humeral head being maneuvered during reduction, with the head finally returning to the glenoid fossa.
Additional Discussion
Whilst plain radiography is the most common imaging modality to diagnose shoulder dislocation and confirm reduction, ultrasound has high sensitivity and specificity(1, 2). Whilst shoulder dislocation and reduction is often clinically evident, it may not be if there is significant swelling or joint instability. In these cases, the portability and immediacy of ultrasound allows rapid confirmation, and if necessary, further reduction attempts (for example whilst the patient is still sedated, if that has been required).
Conclusion
Shoulder ultrasound is a rapid and useful technique for the diagnosis of shoulder dislocation and reduction.
Conflicts of Interest
The authors declare no conflict of interest
References
Attard Biancardi MA, Jarman RD, Cardona T. Diagnostic accuracy of point-of-care ultrasound (PoCUS) for shoulder dislocations and reductions in the emergency department: a diagnostic randomised control trial (RCT). Emerg Med J. 2022;39(9):655-61.
Gottlieb M, Patel D, Marks A, Peksa GD. Ultrasound for the diagnosis of shoulder dislocation and reduction: A systematic review and meta-analysis. Acad Emerg Med. 2022;29(8):999-1007.
Incorrect
CORRECT ANSWER EXPLAINED BELOW
Correct answer is: Glenohumeral joint dislocation
Discussion
The initial image shows the glenoid fossa is ‘empty’ with the humeral head displaced away from the transducer, diagnostic of an anterior glenohumeral joint dislocation. The video demonstrates the humeral head being maneuvered during reduction, with the head finally returning to the glenoid fossa.
Additional Discussion
Whilst plain radiography is the most common imaging modality to diagnose shoulder dislocation and confirm reduction, ultrasound has high sensitivity and specificity(1, 2). Whilst shoulder dislocation and reduction is often clinically evident, it may not be if there is significant swelling or joint instability. In these cases, the portability and immediacy of ultrasound allows rapid confirmation, and if necessary, further reduction attempts (for example whilst the patient is still sedated, if that has been required).
Conclusion
Shoulder ultrasound is a rapid and useful technique for the diagnosis of shoulder dislocation and reduction.
Conflicts of Interest
The authors declare no conflict of interest
References
Attard Biancardi MA, Jarman RD, Cardona T. Diagnostic accuracy of point-of-care ultrasound (PoCUS) for shoulder dislocations and reductions in the emergency department: a diagnostic randomised control trial (RCT). Emerg Med J. 2022;39(9):655-61.
Gottlieb M, Patel D, Marks A, Peksa GD. Ultrasound for the diagnosis of shoulder dislocation and reduction: A systematic review and meta-analysis. Acad Emerg Med. 2022;29(8):999-1007.
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