Images of the week come to us from Dr. Sarah Wolf, who used bedside ultrasound to diagnose an anterior shoulder dislocation, perform the ultrasound-guided joint injection, and confirm successful reduction. To perform the exam the curvilinear probe on the patient’s posterior shoulder parallel to and overlying the scapular spine.
Image 1
On ultrasound, bone is hyperechoic with posterior shadowing. Normally with internal and external rotation of the shoulder, you can visualize the humeral head moving back and forth within the glenoid. In cases of anterior dislocation, the humeral head moves to the far-field of the ultrasound image and joint effusion or hematoma are seen in the space where you would expect to the humeral head to be.
Image 2
After the dislocation was identified, shoulder injection was performed under real-time ultrasound guidance.
Ultrasound can be rapidly performed at the bedside to diagnose dislocation and confirm reduction. Particularly in cases where you do not feel a satisfying pop, the ultrasound can be helpful to confirm reduction immediately at the bedside. Remember, ultrasound cannot consistently show an associated Bankhart or Hill-Sachs deformity, so x-ray imaging is useful to assist your orthopedic colleges with follow-up management. This patient received excellent anesthetic effect with pain medication and joint injection alone and was easily reduced using scapular manipulation, traction and external rotation