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Motorcycle Crash*

 

History of Present Illness:

A 42-year-old male presents to the ED for shoulder pain after a motorcycle accident.   He denies any neck or back pain, chest or abdominal pain or other complaints.  He was wearing a helmet and full leather gear.

Vital Signs & Physical Exam:

Vital signs are normal.   Physical exam shows tenderness and decreased range of motion to the left shoulder

Initial Diagnostic Testing:

  • Imaging: See Below

What is the most likely diagnosis?

  1. AC separation
  2. Anterior dislocation
  3. Posterior dislocation
  4. Shoulder fracture

 

SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT

 

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ANSWER

  1. AC separation: nope
  2. Anterior dislocation: nope
  3. Posterior dislocation: YUP – see axillary view below for confirmation
  4. Shoulder fracture: nope

1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

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CASE CONCLUSION: He went home

CASE LESSONS: Posterior dislocations are rare but are more common in people with lax joints, some of who can voluntarily sublux it (including my son and ex-wife).  In 20 years I’ve seen two malingerers/drug-seekers who were subluxing it, one legit one just from from rolling over in bed and one spontaneously reduced one with a greater tuberosity fracture after a tramadol seizure .

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