Case 16- Anterior Shoulder Dislocation

Author: Dr Gokul Sagar Bailur Reviewer: Dr Nick Mani

Young gentleman attended ED with Left shoulder pain after swinging a baseball bat. X-rays reveal anterior shoulder dislocation. After multiple failed attempts at reduction under Entonox and Penthrox patient underwent procedural sedation.

Post-reduction under sedation, bedside POCUS was used to assess if successful reduction as clinically challenging to determine for certain:

Clip 1- Shoulder joint POCUS from the posterior aspect (curvilinear probe, MSK preset)

POCUS confirmed that the shoulder had still not been successfully reduced. Sedation was continued, and a final attempt at reduction was performed, and POCUS was repeated:

Clip 2- Shoulder joint POCUS repeat from the posterior aspect (curvilinear probe, MSK preset)

Repeat bedside POCUS confirmed successful reduction of the shoulder joint, sedation was weaned down and discontinued, and polysling was applied.

Clips- Shoulder joint POCUS pre and post successful reduction with anatomical annotations

Case Resolution

The patient safely recovered from sedation, and a repeat X-ray was performed which confirmed successful reduction of the shoulder. The patient was discharged home after a period of post-sedation observation, with follow-up care.

Take-home Message

POCUS could be an invaluable tool for confirming successful reduction of shoulder dislocations, potentially preventing the need for re-sedation and further attempts. It could also be utilised for those who have had multiple XRs following repeated non-traumatic shoulder dislocations.