“Put Your Probe on My Shoulder”: Use of POCUS in Shoulder Dislocation

 

Written by: Suji Cha, DO; Edited by: Jeff Greco MD

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Background:

Joint dislocation is a pathology seen frequently in the Emergency Department, with the most common location being the glenohumeral joint. The glenohumeral joint is particularly vulnerable to dislocation due to its wide range of motion and because the humeral head sits incompletely covered within the shallow glenoid fossa. Anterior dislocations account for 95 to 97 percent of these cases, followed by posterior dislocations at 2 to 4 percent, and inferior dislocations at 0.5 percent.

In current practice, x-rays are taken initially to diagnose displacement of the humeral head and to rule out associated injuries. Post-reduction radiographs are taken to confirm the success of the procedure. If the post-reduction x-rays show that the shoulder remains dislocated, the patient and healthcare team would have to undergo the excruciating and tedious process of procedural sedation and reduction for a second time. But, what if I told you there is a way to avoid getting the cold shoulder from the xray tech for ordering repeat imaging and having to offer the patient a shoulder to cry on when you put them through another round of sedation and reduction.

So how exactly can you help shoulder this responsibility? By using Ultrasound!

Studies have shown that POCUS is highly sensitive and specific for the diagnosis of shoulder dislocations. If used to dynamically evaluate the shoulder, it can provide helpful information regarding the need for further manipulation while the patient remains sedated prior to getting the confirmatory x-ray. It may also aid in pain control when used as a guide for intra-articular lidocaine injections.

Technique:

The linear transducer (or the curvilinear, depending on the patient’s body habitus) is used with the operator standing behind the affected shoulder and the ultrasound machine placed in front of the patient. Palpate the patient’s scapular spine and place the probe just inferior to it in transverse position with the probe marker facing the patient’s left side. Slide the probe out laterally until you can visualize the glenoid and the humeral head.

Us findings with intact right shoulder joint (left) vs anterior and posterior shoulder dislocation (right)

Us findings with intact right shoulder joint (left) vs anterior and posterior shoulder dislocation (right)

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Conclusion:

●      Ultrasound can be a helpful tool in guiding the diagnosis of a shoulder dislocation along with confirmation of a successful reduction prior to x-ray studies.

●      On the screen, anterior dislocations show the humeral head deeper than the glenoid and posterior dislocations show the humeral head more superficial.

 

References:

1. Gottlieb M, Holladay D, Peksa GD. Point-of-care ultrasound for the diagnosis of shoulder dislocation: A systematic review and meta-analysis. Am J Emerg Med. 2019;37(4):757-761. doi:10.1016/j.ajem.2019.02.024

2. Gottlieb M, Russell F. Diagnostic Accuracy of Ultrasound for Identifying Shoulder Dislocations and Reductions: A Systematic Review of the Literature. West J Emerg Med. 2017;18(5):937-942. doi:10.5811/westjem.2017.5.34432 

3. Abbasi S, Molaie H, Hafezimoghadam P, et al. Diagnostic accuracy of ultrasonographic examination in the management of shoulder dislocation in the emergency department. Ann Emerg Med. 2013;62(2):170-175. doi:10.1016/j.annemergmed.2013.01.022

4. http://brownemblog.com/blog-1/2016/11/30/pocus-shoulder-dislocation 

5. http://www.emdocs.net/us-probe-ultrasound-for-shoulder-dislocation-and-reduction/

6. https://www.acepnow.com/article/use-point-care-ultrasound-identify-shoulder-dislocation/

 
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