Managing Shoulder Injuries in the Emergency Department: Fracture, Dislocation, and Overuse
72
Publication Date: June 2018 (Volume 20, Number 6)
No CME for this activity
Authors
Richard Pescatore, DO
Director of Clinical Research, Department of Emergency Medicine, Crozer-Keystone Health System, Chester, PA; Clinical Assistant Professor of Emergency Medicine, Rowan University School of Osteopathic Medicine, Stratford, NJ
Andrew Nyce, MD
Vice Chairman and Associate Professor, Department of Emergency Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ
Peer Reviewers
John Munyak, MD
Orthopedic Sports Medicine and Emergency Medicine Physician, Maimonides Bone and Joint Center, Brooklyn, NY
Mark Silverberg, MD, FACEP, MMB
Associate Residency Program Director, Associate Professor of Emergency Medicine, SUNY Downstate/Kings County Hospital Department of Emergency Medicine, New York, NY
Abstract
The complex structures of the shoulder can be injured by fracture, dislocation, and overuse, and correctly identifying and classifying injury is essential to avoiding pain, disability, and life- and limb-threatening complications. This issue presents a systematic approach to classifying shoulder injuries based on the mechanism of injury and clinical presentation, choosing appropriate imaging, and determining the best strategies for treatment, including reduction, surgical consultation, or outpatient referral. Newer recommendations on intra-articular versus intravenous analgesia are presented to increase patient comfort and improve reduction outcomes.
Excerpt From This Issue
You are working in the ED on a July day when the EMS phone blares. The local squad reports that a 21-year-old college student appears to have a clavicle fracture with skin tenting after a slip-and-fall accident. Unsure of the best management for this patient, EMS asks whether they should take the patient to the closest ED, which is a small freestanding facility without orthopedic surgery coverage, or whether the patient needs to be taken to your hospital, which has 24/7 orthopedic surgery consultation availability. Your medical student asks you how you make such a decision...
In the meantime, the next patient you see is a 52-year-old “weekend warrior” with left shoulder pain and limited mobility after being tackled in a game of backyard football. The charge nurse states the shoulder appears dislocated and asks whether you want to “pop it back in” before getting x-rays...
Product Reviews
Well done and thorough. I will increase injections of intra-articular lidocaine prior to reduction. Michael S, MD - 09/10/2018
Excellent review and description of shoulder reduction as well as alternatives to opiods. I will try some more alternatives to reduction of shoulder dislocations Kelly King, MD - 09/07/2018
Well organized and succinct. X rays and drawings were very helpful. William Mckay - 09/04/2018
Excellent educational activity. Daniel Martinez - 07/26/2018
Great review of shoulder reduction techniques, will try new ones in future. J. S., MD - 07/25/2018
This is a very informative presentation inserting shoulder dislocation, clavicular fracture, sternoclavicular dislocations and other issues involving the shoulder joint. I am now aware of the Neer classification proximal humeral fracture and that the highest rate of avascular necrosis occurs with 4 part fractures, I also know not to use an equal clear technique for reducing the dislocated shoulders and his consequences. The Davos method of shoulder reduction appears interesting and I will incorporate this into my practice Michael A Kutmas, DO - 07/23/2018
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