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
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
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