Painful shoulder post fall

Clinical introduction

A 32-year-old man presented to the ED after a heavy fall on his left shoulder. He presented the following day with pain and gross limitation of movement in the left shoulder. There was no history of previous injury to the left shoulder. This was his non-dominant limb and he worked in a manual occupation. He was neurovascularly intact. His initial radiographs are shown in figures 1 and 2.

Question

Management options:

Anterior shoulder dislocation —closed reduction

Anterior shoulder dislocation—CT scan

Posterior shoulder dislocation—closed reduction

Posterior shoulder dislocation—CT scan

Answer: D

These images demonstrate a posterior shoulder fracture–dislocation which is 'locked' posteriorly to the glenoid due to a large reverse Hill-Sachs defect. Posterior shoulder dislocations are rare and easily missed if orthogonal (two perpendicular views) shoulder radiographs are not obtained1; current British Elbow and Shoulder Society...

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