Managing Shoulder Injuries in the Urgent Care: Fracture, Dislocation, and Overuse (Trauma CME)

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Delivery Method:	Online
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Publication Date: July 2024 (Volume 3, Number 7)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 AAFP Prescribed credits, and 4 AOA Category 2-B CME credits. CME expires 07/01/2027.

Specialty CME: Included as part of the 4 credits, this CME activity is eligible for 4Trauma CME credits, subject to your state and institutional requirements.

Authors

Peer Reviewer

Abstract

Shoulder pain is a frequent complaint in urgent care patients. Complaints may be related acutely (due to injury) or chronically (due to overuse). Correct diagnosis of an acute injury is essential to preventing chronic pain, disability, and life- and limb-threatening complications. This review presents a systematic approach to managing shoulder pain in the urgent care setting by providing a framework for classification using mechanism of action and clinical presentation. Appropriate imaging studies and treatment are discussed, along with the indications for immobilization and outpatient referral, versus emergency department evaluation for more serious injuries that need emergent, definitive care.

Case Presentations

A 21-year-old man presents to urgent care after a slip-and-fall accident...

• He appears to have a clavicle fracture with skin tenting.
• You immediately consider whether this patient should be sent directly to the ED…

A 52-year-old man arrives in the urgent care clinic with left shoulder pain and limited mobility...

• The injury was sustained when he was tackled in a game of backyard football.
• The nurse states the shoulder appears dislocated and asks whether you want to “pop it back in” before getting x-rays…

A 55-year-old woman presents to urgent care after falling on an outstretched hand a few weeks prior...

• At the time of the incident, she was treated appropriately for a proximal humerus fracture but did not follow up with orthopedics or physical therapy.
• Today she is complaining of increasing shoulder pain and difficulty with range of motion…

A 60-year-old man with diabetes arrives with right shoulder pain that is worsened when he sleeps on that side...

• The patient states he is a construction worker and uses “vibratory tools” on a daily basis.
• His pain has gradually worsened to the point that daily activities such as putting on a shirt or combing his hair have become intolerable…

Your clinic secretary stops you in the parking lot…

• After suffering what she says was a shoulder sprain nearly a month ago, she reports worsening right shoulder pain and limitation in range of motion.
• The arm has been carefully guarded in a sling, and she asks if you could write her a prescription for oxycodone…

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.