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Shoulder Pain

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History of Present Illness:

A 22-year-old male presents to the ED for right shoulder pain after rolling over in bed and hearing a crack.  He says he has felt like the shoulder has gone out before but it always pops back in.    He denies  or other complaints

Vital Signs & Physical Exam:

Vital signs are normal.  Physical exam is normal except for guarding of right shoulder

Initial Differential Diagnosis: 

Relevant Test Results:

  • Imaging: See below

QUESTIONS:

  1. What does the case image show?  
  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 with a light-bulb sign.  For more about this, google it or click here
  2. What should you do next?  Confirm with a scapular Y view (see below) or axillary view.  Treat with pain meds then reduce.  Consult ortho.
  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

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CASE CONCLUSION: Reduced without sedation and sent for ortho follow-up

 

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