Dimple on the shoulder after a ski injury

Clinical introduction

A 74-year-old woman was brought to the ski clinic shortly after a fall on her left shoulder while skiing. She did not remember the exact fall mechanism. She felt a popping sensation in her left shoulder and was unable to move her left arm due to severe pain. Her medical and social histories were unremarkable. On physical examination, she had a deformity in her left shoulder (figure 1). Her neurovascular examination was intact.

Figure 1

Photograph of the left shoulder on arrival showing an anterior 'dimple'.

Question

What is the most likely diagnosis of the injury?

An acromioclavicular joint (ACJ) sprain (shoulder separation)

A proximal humerus fracture

A distal clavicle fracture

A posterior glenohumeral dislocation

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