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Motorcycle Crash

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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 Differential Diagnosis:

  • AC separation
  • Clavicle fracture
  • Shoulder dislocation
  • Shoulder fracture
  • Syphilis, the great imitator

Initial Diagnostic Testing:

  • Imaging: See Below

QUESTIONS:

  1. What does the case image show?  (click two times to enlarge)
  2. What should you do next?  
  3. Want a 1-minute consult/tutorial on this case? 
  4. Want to know what happened with this patient?

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ANSWERS:

  1. What does the case image show?  The image shows a posterior shoulder dislocation.  See the axial view below.
  2. What should you do next?  Reduce it
  3. Want a 1-minute consult/tutorial on this case?  See yellow area from sample page below.
  4. Want to know what happened with this patient?  See case conclusion below tutorial page.

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

CLICK HERE TO LEAR MORE ABOUT THIS BOOK

CASE CONCLUSION: He went home

CASE LESSONS: This is super rare.  Only seen one legit one in 20 years.  Also have seen two fakers and one likely spontaneously reduced one after a seizure with a greater tuberosity fracture.

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