Author: David Raven / Editor: Jason M Kendall / Reviewer: Phil Delbridge, Mark Brown / Codes: SLO4, TP7, VC1 / Published: 06/12/2023
A 51-year old man presents at 3am to the Emergency Department (ED) with severe pain in his left arm. He had been playing Rugby the day before and had been tackled heavily, forcing him to land on his left shoulder. He had been taken to another ED and diagnosed with an anterior shoulder dislocation, which had been relocated under sedation using a Kocher’s method of reduction. Post reduction X-Rays were normal.
On assessment, he is alert and complaining of severe pain around his left shoulder, radiating down the arm to his fingertips. Examination reveals reduction in power (3/5 C5 – T1) and marked sensory loss from C5 to T1 with prolonged capillary refill time of 3 seconds and a weakened radial pulse.
Repeat shoulder X-rays confirm that the humeral head is still in position.
MRI Scan of the Shoulder is shown:
9 responses
Great case
Really good case emphasising the importance of neurovascular examination and to keep looking for alterante diagnoses when there is unexpected and ongoing pain.
Interesting
Good review case
Definitely taught me something about the angiography!
Rare. But interesting
Excellent Review
Excellent case and a few good learning points. Thank you
interesting case