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?
- AC separation
- Anterior dislocation
- Posterior dislocation
- Shoulder fracture
SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT
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ANSWER
- AC separation: nope
- Anterior dislocation: nope
- Posterior dislocation: YUP – see axillary view below for confirmation
- Shoulder fracture: nope
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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 .