MSK Ultrasound for Shoulder Dislocation
October 2, 2020
Written by Alex Chen
Spoon Feed
This posterior ultrasound (US) approach to identify shoulder dislocation had 100% sensitivity and specificity for shoulder dislocation and was faster than x-ray by 43 minutes. However, the 92% sensitivity (with a lower 95% CI of 60%) for identifying non-Hill-Sachs/Bankart fracture makes me cautious about completely adopting POCUS until larger studies are done.
Why does this matter?
Shoulder dislocation is a common presentation to the ED. It can range from an easy reduction to one that requires procedural sedation and a great deal of your time and energy. Getting a patient to and from x-ray and coordinating resources can be a pain, and this study seeks to provide an easier and more expeditious way for you to diagnose and manage a shoulder dislocation.
“Let me see you bounce right to left and let your shoulder lean.” – Young Dro regarding posterior shoulder ultrasounds.
This was a multicenter prospective observational study with 65 total patients enrolled. Patients were enrolled if they were ≥18yo and had a suspicion of shoulder dislocation. All POCUS exams were done by US fellowship trained/in-training faculty. Sensitivity of posterior shoulder US for identifying shoulder dislocation was 100% (95% CI 87-100) and specificity was 100% (95% CI 87-100). POCUS improved time to performance of imaging by a median of 43 minutes (IQR 23-60) and took a median time of 19 seconds to perform.
Of the 65 patients, there were 25 (38%) fractures identified on radiography. POCUS identified 13/25 (52%) of the fractures. Of the 12 missed, only one was a non-Hill-Sachs/Bankart fracture (fracture of the surgical neck of the humerus). The sensitivity of POCUS for identifying non-Hill-Sachs/Bankart fracture was 92% (95% CI 60-99.6) and the specificity was 100% (95%CI 92-100). While this was only one patient in this study, this could lead to significant morbidity. While a Hill-Sachs or Bankart lesion does not alter our acute management of the shoulder dislocation in the ED, it does play into the follow-up, future risk of dislocation, and morbidity in these patients. The authors admit that this view does not provide a sufficient view of the glenoid and limits the diagnosis of these lesions. For me, I will likely be implementing this to gauge post-reduction success or in patients with recurrent shoulder dislocation without any trauma (low risk of fracture). Please see the following images copied from the paper for the ultrasound method.
![](https://i0.wp.com/journalfeed.org/wp-content/uploads/2022/02/ScreenShot2020-09-22at9.16.13AM.png?resize=1024%2C605&ssl=1)
![](https://i0.wp.com/journalfeed.org/wp-content/uploads/2022/02/ScreenShot2020-09-22at9.16.33AM.png?resize=810%2C1024&ssl=1)
Source
Musculoskeletal Ultrasonography to Diagnose Dislocated Shoulders: A Prospective Cohort. Ann Emerg Med. 2020 Aug;76(2):119-128. doi: 10.1016/j.annemergmed.2020.01.008. Epub 2020 Feb 25.
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