Working Diagnosis:
Posterior Shoulder Dislocation with Reverse Hill-Sachs Lesion with multiple bony fragments.

Treatment:
Patient was admitted to hospital for definitive orthopedic surgical management. Patient underwent an open reduction of left posterior shoulder dislocation, transfer of lesser tuberosity, and biceps tenodesis.

Outcome:
Intra-operative and post-operative imaging confirmed successful reduction. Case Photo #5 Patient immobilized with a sling and abduction pillow in neutral position. Patient to start physical therapy upon discharge and is expected to male a full recovery.

Author's Comments:
A benefit of bedside musculoskeletal ultrasonography is to allow for quick diagnosis of anterior or posterior shoulder dislocation with or without bone injury. It can also be used for dynamic real-time imaging of the articulation between the glenoid fossa and humeral head to allow for evaluation of reduction during manipulation with or without procedural sedation. This reduces potential for delay in confirmation of successful or unsuccessful reduction attempts and reduces potential for prolonged discomfort or disability for the patient. Case Photo #6 Case Photo #7

Editor's Comments:
Posterior shoulder dislocations are not as common as anterior dislocations, but should be in the differential for patient with visible deformity and limited range of motion. Point of care ultrasound can be helpful to diagnose and confirm successful reduction, limiting patient radiation.

References:
1. Abbasi S, Molaie H, Hafezimoghadan P, et al. Diagnostic accuracy of ultrasonographic examination in the management of shoulder dislocation in the emergency department. Annals of Emergency Medicine. 2013: 1-6.
2. Ebraheim N, Shoulder Dislocations-Everything You Need To Know. https://www.youtube.com/watch?v=xDePRKeB4kc
3. Jacobson J. Fundamentals of Musculoskeletal Ultrasound. Saunders. 2007. 39-48
4. Images obtained from http://www.doccottlesdesk.blogspot.com
5. Images obtained from http://www.emdocs.net
6. Riguzzi C, Mantuani D, Nagdev A. How to use point-of-care ultrasound to identify shoulder dislocation. ACEP Now. 2014.
7. Wolfson A, Cloutier R, Nagdev G, Ling L, Rosen C, Schaider J, Harwood-Nuss' Clinical Practice of Emergency Medicine. Wolters Kluwer Health/Lippincot Williams & Wilkins. 2015. 247-252.

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