Dislocated Shoulder - Diagnosis

What kinds of exams or tests led to a diagnosis of a dislocated shoulder?

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How do physicians diagnose dislocated shoulders?

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 professional to take a careful history to understand the mechanism of injury and the circumstances surrounding it. It will also be important to know if this is the first shoulder dislocation or whether the joint has been previously injured. In addition, questions may be asked about medications, allergies, time of the last meal, and past medical history to prepare for a potential anesthetic administration to help relocate, or reduce, the shoulder dislocation.

Physical examination of the shoulder will begin with inspection. In an anterior dislocation, the shoulder appears to look "squared off," with 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. Posterior dislocations may be difficult to assess just by looking at the shoulder joint.

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. The health-care professional may feel for pulses in the wrist and elbow, as well as test for sensation to assess the blood and nerve supply to the arm. One place where sensation is tested is the lateral or outside part of the shoulder, also called the deltoid badge area. Numbness may signal damage to the 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.

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 difficult.

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 -- anteriorly (in front) or posteriorly (behind) 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 professional 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.

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