Locating the Dislocation: Shoulder Ultrasonography

 https://commons.wikimedia.org/wiki/File:The_luxation_of_a_dislocated_shoulder,_16th_century._Wellcome_M0014889.jpg

https://commons.wikimedia.org/wiki/File:The_luxation_of_a_dislocated_shoulder,_16th_century._Wellcome_M0014889.jpg

Why use bedside ultrasound for suspected shoulder dislocations?

Use of bedside ultrasound in shoulder dislocations DECREASES:

  • Use of narcotics
  • Number of sedations
  • Patient length of stay
  • Cost
  • Radiation

Visualizing the Glenohumeral Joint with Ultrasound

  • Use the curvilinear array probe
  • Feel the spine of the scapula with your finger
  • Place the ultrasound probe horizontally and just beneath the scapular spine, sliding slightly lateral
  • Indicator on the probe should be pointed toward the left side of the patient (and most importantly the ultrasound operator's left)
  • Place the ultrasound screen in front of you (so what is left on the screen is left on the patient in front of you; this will help with hand eye coordination during lidocaine injection)
  • Identify the glenohumeral joint 

 

 

Ultrasound of the Glenohumeral Joint

Normal Glenohumeral Joint

  • Internal and external rotation of the humerus helps identify the humeral head and rotator cuff

  • The glenoid/scapula does not move with rotation

 

Anterior Shoulder Dislocation

  • Humeral head is no longer in continuity with glenoid

Intra-articular Injection of Lidocaine into the Glenohumeral Joint

  • Anesthetize superficial skin and subcutaneous fascia with 1% lidocaine and small tuberculin syringe
  • Use an 18-20 G spinal needle to reach the joint space
  • Place your needle right next to the probe so you can follow it until it reaches the joint space
  • Aspiration of hemarthrosis will also help confirm placement
  • Inject 20cc of 1% lidocaine into the joint space where the humeral head should be located 
  • Wait 10-15 minutes prior to manipulation
 

Check out this great post on shoulder ultrasonography on EM Docs

 

Tired of reading?  Watch Dr. Croft discuss shoulder sonography at ouR 2017 Winter Symposium


Written by Jeffrey A Holmes, MD with Peter Croft, MD

Edited and Posted by Jeffrey A. Holmes, MD


References
1.  Waterbrook, Anna L., and Stephen Paul. “Intra-Articular Lidocaine Injectionfor Shoulder Reductions: A Clinical Review.” Sports Health 3.6 (2011): 556–559.  PMC. Web. 9 Feb. 2017.
2.  Marx, John A, Robert S. Hockberger, Ron M. Walls, Michelle H. Biros, Daniel F. Danzl, Marianne Gausche-Hill, Andy Jagoda, Louis Ling, Edward Newton, Brian J. Zink, and Peter Rosen. Rosen's Emergency Medicine: Concepts and
Clinical Practice. , 2014. Chapter 53, 618-642.e2
3.  Abbasi S, Molaie H, Hafezimoghadam P, Zare MA, Abbasi M, Rezai M, Farsi D. Diagnostic accuracy of ultrasonographic examination in the management of shoulder dislocation in the emergency department. Ann Emerg Med. 2013 Aug; 62(2):170-5. doi:10.1016/j.annemergmed.2013.01.022. Epub 2013 Mar 13.
4.  Emond M, Le Sage N, Lavoie A, Rochette L. Clinical factors predicting fractures associated with an anterior shoulder dislocation. Acad Emerg Med. 2004Aug;11(8):853-8.
5.  Gottlieb M, Edwards H. BET 1: Utility of ultrasound in the diagnosis of shoulder dislocation. Emergency medicine journal : EMJ. 33(9):671-2. 2016
6.  Stolz L, O’Brien KM, Miller ML, Winters-Brown ND, Blaivas M, Adhikari S. A Review of Lawsuits Related to Point-of-Care Emergency Ultrasound Applications. Western Journal of Emergency Medicine. 2015;16(1):1-4.