Q1:
A 12-year-old basketball player presents to your office with an acute shoulder injury. He reports
that an opponent ran into his left, posteriorly outstretched arm as he was guarding him. He
developed pain in his left shoulder and has been unable to move his arm since the injury.
Physical examination reveals asymmetry of his shoulders, with increased shoulder slope on the
left. The left arm is externally rotated and slightly abducted. Fullness is palpable inferior to the left
mid-clavicle, and there is no pinprick sensation over the lateral deltoid. You place the patient’s
left arm in a sling, administer acetaminophen and codeine, and send him for radiographs.
Of the following, the MOST helpful radiographic view for diagnosing his injury is
A. anteroposterior view of the clavicle
B. anteroposterior view of the humerus
C. anteroposterior view of the left scapula
D. axillary view of the shoulder
E. lateral view of the humerus
Answer
D
Shoulder dislocations are relatively uncommon injuries in children and adolescents because of
the strength of the shoulder capsule and the glenohumeral ligaments.
Most often seen in sportsrelated trauma, these injuries should be reduced urgently in an appropriate setting.
Most shoulder dislocations involve anterior displacement of the humeral head, resulting from posteriorly directed force on an abducted, extended arm.
The patient complains of significant shoulder pain and holds the arm slightly abducted in external rotation, as described for the boy in the vignette.
The humeral head may be palpated inferiorly to the mid-clavicle on the affected side. The axillary nerve is the most commonly injured nerve following anterior shoulder dislocation, and its function should be assessed and documented. Axillary nerve injury results in numbness over the deltoid and the inability to abduct or extend the shoulder>
Although the diagnosis typically is based on clinical findings, radiographs are indicated for confirmation and to evaluate for any associated bony abnormalities, such as fractures of the humeral head or glenoid fossa .
The initial radiologic evaluation should include anteroposterior, lateral, and axillary views of the shoulder.
The axillary view is the most sensitive for seeing the relationship between the humeral head and the glenohumeral fossa.
Humeral, scapular, or clavicular radiographs alone are not adequate to assess the location of the humeral
head.
Answer
D
Shoulder dislocations are relatively uncommon injuries in children and adolescents because of
the strength of the shoulder capsule and the glenohumeral ligaments.
Most often seen in sportsrelated trauma, these injuries should be reduced urgently in an appropriate setting.
Most shoulder dislocations involve anterior displacement of the humeral head, resulting from posteriorly directed force on an abducted, extended arm.
The patient complains of significant shoulder pain and holds the arm slightly abducted in external rotation, as described for the boy in the vignette.
The humeral head may be palpated inferiorly to the mid-clavicle on the affected side. The axillary nerve is the most commonly injured nerve following anterior shoulder dislocation, and its function should be assessed and documented. Axillary nerve injury results in numbness over the deltoid and the inability to abduct or extend the shoulder>
Although the diagnosis typically is based on clinical findings, radiographs are indicated for confirmation and to evaluate for any associated bony abnormalities, such as fractures of the humeral head or glenoid fossa .
The initial radiologic evaluation should include anteroposterior, lateral, and axillary views of the shoulder.
The axillary view is the most sensitive for seeing the relationship between the humeral head and the glenohumeral fossa.
Humeral, scapular, or clavicular radiographs alone are not adequate to assess the location of the humeral
head.
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