What's the Diagnosis? By Dr. Loran Hatch

A 40 yo M with a history of alcohol abuse presents to the ED with R shoulder pain after witnessed seizure like activity. He reports a history of shoulder dislocation in the past. An x-ray is obtained. What's the diagnosis? (scroll down for answer)



Answer: Anterior Shoulder Dislocation

  • Most common direction of dislocation following trauma
  • Mechanism of injury: arm is forced into abduction, external rotation and hyperextension
  • Patients present w/ pain, arm held in abduction, limited ROM, and and abnormal contour of shoulder
  • XR imaging: true AP, scapular Y and axillary views
  • Commonly associated w/ Bankart lesion (tear of anterior glenoid labrum or glenoid bone), Hill Sachs lesion (compression fracture of posterior humeral head), labrum lesion (SLAP tear), hemarthrosis, axillary nerve injury
  • High rate of recurrence- young males, contact sports, those w/ bony defects, ligament laxity, hypermobility
  • Multiple different reduction techniques are described-  traction/counter-traction, Kocher (external rotation), scapular manipulation, Stimson (prone w weight)
  • Consider procedural sedation or intra-articular injection
  • Immobilize w/ sling for 1-3 weeks, orthopedic follow up 



Patrick Kane, Shawn M. Bifano, Christopher C. Dodson & Kevin B. Freedman (2015) Approach to the treatment of primary anterior shoulder dislocation: A review, The Physician and Sportsmedicine, 43:1, 54-64.

Bjoernsen, Lars Petter, and Alexander Ebinger.. "Shoulder and Humerus Injuries." Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e Eds. Judith E. Tintinalli, et al. New York, NY: McGraw-Hill, 2016