1/8. The often overlooked posterior dislocation of the shoulder.Unlike most shoulder dislocations, the posterior dislocation is truly a diagnostic challenge to the treating physician because it may be missed more often than it is recognized. In fact, more than 60% of posterior dislocations are misdiagnosed initially by the treating orthopedic surgeon, and the correct diagnosis is often delayed for months or years. A history of seizures, electroshock, or a fall onto a flexed, adducted arm should alert the physician to the possibility of posterior dislocation. A careful physical examination with comparison to the unaffected arm must be performed with particular attention given to subtle posterior fullness and anterior flatness of the shoulder, along with a lack of external rotation and abduction. A radiographic trauma series made in the scapular plane must always be obtained in cases of shoulder trauma to rule out posterior dislocation. A computed tomographic scan may also be necessary. The correct diagnosis of this injury will facilitate proper orthopedic evaluation and treatment and will reduce the incidence of missed posterior shoulder dislocation and its associated morbidity.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/8. axillary artery injury secondary to anterior shoulder dislocation: report of two cases.Vascular injuries secondary to isolated shoulder dislocation are rare. Unawareness for closed axillary artery trauma by many physicians treating shoulder dislocations, counts often for missed or delayed diagnosis. The authors describe two cases that presented with an anterior shoulder dislocation, complicated by a disruption of the axillary artery with subsequent thrombosis. The various pathogenic mechanisms are discussed. The pathognomic triad consists of anterior shoulder dislocation, absent or diminished distal pulse and an axillary protruding hematoma. Prompt surgical arterial repair is mandatory.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
3/8. Locked anterior-inferior shoulder subluxation presenting as luxatio erecta.Shoulder subluxation may present as a complication of either traumatic injury to a joint, repetitive mictrotrauma, or atraumatic joint laxity. The case of a middle-aged man who presented with a confusing clinical picture similar to inferior shoulder dislocation, luxatio erecta, with a radiographic diagnosis of anterior-inferior shoulder subluxation is discussed. An understanding of the differential diagnosis of shoulder dislocation and subluxation and the management of atypical presentations is critical to the emergency physician.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
4/8. Ultrasound-guided interscalene block for shoulder dislocation reduction in the ED.Shoulder dislocations are often associated with significant pain, and many emergency physicians choose conscious sedation to achieve reduction. Concerns about oxygenation, airway protection, and aspiration may make some patients poor candidates for conscious sedation. Ideally, complete pain control and muscle relaxation could be achieved without airway compromise. Interscalene nerve blocks are routinely used for shoulder surgery in the operating suite. The equipment required to locate the nerve plexus blindly is typically not available in the ED setting. Recent work has shown that ultrasound guidance is ideal for the interscalene block and would make it possible in the ED. We present 4 cases of patients receiving ultrasound-guided interscalene blocks for pain control and muscle relaxation during shoulder reduction. Complete pain control, muscle relaxation, and joint reduction were achieved in each case.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
5/8. Nerve injury following shoulder dislocation: the emergency physician's perspective.We describe the case of a 57-year-old woman who presented to the emergency department with a right anterior shoulder dislocation following a fall onto the right shoulder and right upper arm. She also complained of numbness in the right forearm and dorsum of the right hand. The examination revealed a bruise to the upper aspect of the right arm resulting from the impact following the fall. The patient also had a right wrist drop and loss of sensation in the lateral border of the right forearm and on the dorsum of the right hand, suggesting a radial nerve injury. She also had altered sensation in the ulnar distribution of her right hand, suspicious of concomitant ulnar nerve injury. No loss of sensation in the distribution of the axillary nerve (regimental patch) was observed. These findings were carefully documented and the patient subsequently had the shoulder reduced under entonox and morphine. The neurological deficits remained unchanged. The patient was sent home from the emergency room with arrangements for orthopaedic and physiotherapy follow-up. After a 3-month period, she had clinical and electromyography evidence of persistent radial and ulnar nerve deficit. She continues to have physiotherapy. This case highlights the need for awareness of the potential for nerve damage following shoulder dislocation and also to ensure that appropriate follow-up plan is instituted on discharge from the emergency department.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
6/8. Luxatio erecta: the inferior glenohumeral dislocation.Luxatio erecta, or inferior glenohumeral dislocation, is a rare shoulder dislocation usually caused by a hyperabduction injury to the arm. We have reviewed the literature consisting of 80 cases of luxatio erecta and also discuss six additional cases that we have treated. The literature shows that either a fracture of the greater tuberosity or a rotator cuff tear was associated with this injury in 80% of patients; 60% of the patients reviewed sustained some degree of neurologic compromise, most commonly to the axillary nerve. These injuries usually resolved; the time for recovery varied from 2 weeks to 1 year. Only 3.3% of the cases demonstrated significant vascular compromise, but this is the highest incidence for any shoulder dislocation. Doppler studies of the affected arm or observation of the patient overnight are recommended because of the potentially disastrous complications of vascular insufficiency. If there is any indication of a vascular problem, immediate arteriogram is indicated. Although usually fairly easily reduced by overhead traction, the lesion is so rare that few physicians are familiar with the technique of reduction. fluoroscopy was used in our most recent cases and was helpful in obtaining a complete and safe reduction.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
7/8. Bilateral inferior glenohumeral dislocation: luxatio erecta, an unusual presentation of a rare disorder.Luxatio erecta, or inferior shoulder dislocation, is a rare form of shoulder dislocation. The case of a patient presenting with bilateral luxatio erecta, which was initially felt by EMS personnel to be an hysterical reaction, is discussed. An awareness of this rare entity, the potential-associated musculoskeletal and neurovascular injuries, and the proper treatment are essential for emergency physicians.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
8/8. Recurrent posterior glenohumeral dislocation associated with increased retroversion of the glenoid. A case report.Recurrent traumatic posterior glenohumeral dislocation is rare and probably represents < 5% of all recurrent shoulder instability cases. Operative management of this problem is considered when symptomatic recurrent instability occurs despite an adequate physician-directed rehabilitation program. Before surgery, it is essential to recognize all directions of instability and any anatomic factors that may predispose the shoulder to recurrent instability, such as humeral head or glenoid defects, abnormal glenoid version or other anthropomorphic abnormalities, rotator cuff tears, neurologic injuries, or generalized ligamentous laxity. The authors report on a patient who had 2 previous failed attempts at posterior capsulorrhaphy for recurrent posterior shoulder dislocation after an atraumatic injury. The patient demonstrated a previously unrecognized unilateral increase in glenoid fossa retroversion and was successfully treated with a posterior opening wedge osteotomy of the scapular neck.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |