A 22 y.o. woman fell from her horse; she has pain over the L shoulder and is sent from an urgent care

What is wrong?

 what do you want to do?

what do you want to do?

Our patient had a pseudodislocation of the shoulder.  This results from an occult fracture that distends the joint due to blood.  It can be recognized by viewing the transcapular or axillary view.  As seen below where the humeral head in in the glenoid.

 humeral head in the glenoid on axillary view; not dislocated. 

humeral head in the glenoid on axillary view; not dislocated. 

Proximal humerus fractures are common injuries in the elderly. They represent 4-5% of fractures; with 80-85% being minimally displaced.  Fairbank reported a 10% occurrence of pseudodislocation following proximal humerus fractures.   In some cases fat can be seen along with the fluid in the joint space.

sdlipohemarthrosisf.JPG
 from Magid

from Magid

 Us showing fluid in the joint 

Us showing fluid in the joint 

 

http://teamrads.com/index.php/radiology-elective/musculoskeletal/shoulder

Hussein MK, the Kocher technique J Bone Joint Surg. . 50B 1968 669-671.

Qamamoto T, Yoshiya S, Kurosaka M et al. Luxatio erecta (inferior dislocation of the shoulder) a report of 5 cases and a review of the literature. American Journal of Orthopedics. 32(12) 601-3.

Hawkins RJ, Neer CS, Pianta RM, Mendoza FX Locked posterior dislocation of the shoulder 1987 J Bone Joint Surg AM 69(1)9-18.

shoulderdis.JPG