OCAD MSK

History

28 yr old male 8 wks post clavicle fracture with continued severe pain and LROM, r/o rotator cuff tear

Figure 1 for case dislocation ( RID4770 ) — Figure 1

Figure 2 for case dislocation ( RID4770 ) — Figure 2

Figure 3 for case dislocation ( RID4770 ) — Figure 3

Figure 4 for case dislocation ( RID4770 ) — Figure 4

Figure 5 for case dislocation ( RID4770 ) — Figure 5

Discussion

Posterior shoulder dislocations are often missed by treating physicians and delayed diagnosis is common. Missed and delayed diangoses contribute to longterm disability and are a significant source of liability in MSK trauma. In this case the referrer is a physiatrist with a non-operative sports medicine practice. In office radiographs (unavailable) showed the clavicle fracture. These studies were obtained because of persistent severe LROM (none, I presume) and pain. The posterior dislocation is partially visible in our clavicle XRs. Given the enormous size of the reverse Hill Sachs, the arm is not forced into internal rotation. I believe the humeral head is impinging on the axillary nerve, resulting in acute denervation edema of the teres minor.

Diagnosis

dislocation ( RID4770 )

Hilary Umans, MD

Courtesy

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