What kinds of exams or tests led to a diagnosis of a dislocated shoulder?
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How is a dislocated shoulder diagnosed?
When a patient presents with a shoulder dislocation, pain control and joint
relocation are primary considerations. However, it is still important for the
health-care provider to take a careful history to understand the mechanism of
injury and the circumstances surrounding it. In addition, information about
medications, allergies, time of the last meal, and past medical history may be
asked to prepare for a potential anesthetic administration to help relocate, or
reduce, the shoulder dislocation. It will also be important to know if this is
the first shoulder dislocation or whether the joint has been previously injured.
Pain and muscle spasm accompany dislocated joints, and a shoulder dislocation
is no different. When the joint is disrupted, the muscles surrounding it are
stretched and go into spasm. The patient will experience significant pain and
will often resist the smallest movement of any part of the arm.
Physical examination of the shoulder will begin with inspection to look for
"squaring off," or a loss of the normal rounded appearance of the shoulder
caused by the deltoid muscle. In thinner patients, the humeral head may be
palpated or felt in front of the joint.
The health-care provider may examine the blood and nerve supply to the arm
since injuries may occur to arteries and nerves when the shoulder is dislocated.
The brachial plexus, the axillary artery, and axillary nerve are located in the armpit and are relatively unprotected. Complications of shoulder dislocation can include artery and nerve damage.
Plain X-rays may be taken to confirm the diagnosis of shoulder dislocation
and to make certain there are no broken bones associated with the dislocation.
Two common fractures are the Hill-Sachs deformity, a compression fracture of
the humeral head, and a Bankart lesion, a chip fracture of the glenoid fossa.
While these may be present, they do not hinder the relocation of the shoulder.
Other fractures of the humerus and scapula may make shoulder reduction more
Since the body is 3-D and X-rays are 2-D, at least two X-rays
are taken to be able to accurately assess where the humeral head is located in
relationship to the glenoid. Extra X-ray views also better assess the bones,
looking for fracture.
In certain circumstances, (often on the athletic field) if a health-care provider is present at the time of injury, an attempt may be made to reduce or relocate the shoulder immediately without
X-rays being taken. Using manipulation described below, before the muscles have a chance to go into spasm, it is possible to relocate the shoulder. Imaging of the injured shoulder (X-ray or MRI) would then be considered at a later time.