Shoulder and elbow emergencies

Glenohumeral dislocations Key facts • Anterior shoulder dislocations are usually clinically obvious • Posterior shoulder dislocations can be difficult to identify • The shoulder is the most commonly dislocated joint in the body • 95% of shoulder dislocations will be anterior • Patients < 30 years of age have a high risk of recurrence Clinical presentation • The shoulder is the most commonly dislocated joint in the body • 95% of shoulder dislocations will be anterior • Patients have a squared-off appearance to the shoulder • The arm is held in slight abduction • Posterior dislocations can be difficult to detect by appearance alone • Patients often hold the arm adducted to the side • Seizures are classically associated with posterior dislocations • A thorough neurovascular exam of the affected extremity is essential to exclude a neurovascular injury • The axillary nerve is most commonly injured PEARL: Patients over the age of 40 should be evaluated for a possible rotator cuff tear, which may occur in greater than one-third of patients with glenohumeral dislocations. Diagnostic testing • Plain films of the shoulder are the test of choice • Perform an AP (Figure 2.1A) and a lateral projection (axillary lateral or scapular Y-view) (Figure 2.1B) PEARL: Failure to obtain a lateral projection can result in missing a posterior dislocation in up to 50% of cases.