The Saga Continues: Posterior Shoulder Dislocation

We finish our shoulder dislocation series by paying our respects to posterior shoulder dislocation. Posterior shoulder dislocations are rare, and account for less than 4-5 percent of all shoulder dislocations, but all ED providers should know how to identify and relocate these injuries. Cases of misdiagnosis and even late diagnosis can occur. Early recognition and appropriate management can save a patient from complicated issues related to the dislocation as well as chronic pain. Anteroposterior (AP) view, left, of a patient with a posterior dislocation. This dislocation may be difficult to appreciate on an AP view because it is not inferiorly displaced and may appear to be in the glenoid fossa. Note that the space between the glenoid fossa and the humeral head does not look normal. The scapular Y view, right, reveals that a posterior dislocation is present. Note that the humeral head lays posterior to the glenoid fossa rather than being centered over it.   The provider will note on physical exam that patients commonly present with a triad of internal rotation, adduction, and flexion. The physical exam, as always, is key; do not rely on films as your only source of information. You will find it quite difficult and painful if you try to abduct or externally rotate the patient’s arm. Various studies reviewed on UpToDate (2013) show that comparing one shoulder with another is not always resourceful because these injuries present bilaterally depending on the mechanism of inju...
Source: The Procedural Pause - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs