FOOSH It Good

BY LOICE SWISHER, MDA young woman came in after a FOOSH injury complaining of difficulty moving a painful shoulder. The Y view was difficult to obtain, but the AP view is below. What three radiographic signs help make the diagnosis? The signs include:The light bulb sign is when the humeral head is rotated internally so it looks more like a lightbulb than a club.The rim sign where there is an increased distance (more than 6 mm) between the arc of the glenoid and the arc of the humeral head. The distance is much closer at the top of the glenoid than the bottom in this image.There is an angle in Moloney's arch. There should be a smooth scapulohumeral arch. Peaks in the glenohumeral location should raise suspicion of a posterior shoulder dislocation. The equivalent of Moloney's arch in the hip is Shenton line.This is a posterior dislocation. These account for only two to four percent of shoulder dislocations, and they can look remarkably normal in general location, which means as many as 50 percent have been reported to be missed on initial radiographs. A good Y view can be exceedingly helpful in making the diagnosis.Request an axillary view or a CT if a Y view is difficult. Bedside ultrasound is likely the quickest way to confirm the diagnosis for those skilled at musculoskeletal point-of-care scanning. A diagnostic Y view was eventually obtained. The shoulder was put back using a traction-counter traction technique under conscious sedation.​Tips to Remember:...
Source: The Procedural Pause - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs