Emergency Department Evaluation and Treatment of the Shoulder and Humerus

Blake, Robert W.; Hoffman, Joe D.

doi:10.1016/s0733-8627(05)70101-2

Cited by 45 publications

(23 citation statements)

References 29 publications

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“…6 Some authors have argued that our outcome is debatable; clinically important fracture-dislocation may or may not need to be identified before reduction from a patient care point of view. 3,6,17,18 In 2003, Perron and colleagues 19 showed that all shoulder dislocations in a retrospective cohort of patients who were seen in a single academic centre were reduced in the ED. However, this review did suffer from systematic data collection and incomplete radiographic evaluations, while missing important injuries.…”

Section: Discussionmentioning

confidence: 99%

Refinement of the Quebec decision rule for radiography in shoulder dislocation

Émond

Sage

Lavoie

et al. 2009

CJEM

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Objective:We prospectively derived a clinical decision rule to guide pre-and postreduction radiography for emergency department (ED) patients with anterior glenohumeral dislocation. Methods: This prospective cohort derivation study took place at 4 university-affiliated EDs over a 3-year period and enrolled consenting patients with anterior glenohumeral dislocation who were 18 years of age or older. We compared patients with a clinically important fracture-dislocation with those who had an uncomplicated dislocation to provide the clinical decision rule components using recursive partitioning. The final rule involved age, mechanism, prior dislocation and humeral ecchymosis. Results: A total of 222 patients were included in the study. Forty (18.0%) had clinically important fracture-dislocation. A clinical decision rule using 4 factors reached a sensitivity of 100% (95% confidence interval [CI] 89.4%-100%), a specificity of 34.2% (95% CI 27.7%-41.2%), a negative predictive value of 99.2% (95% CI 92.8%-99.9%) and a negative likelihood ratio of 0.04 (95% CI 0.002-0.27). Patients younger than 40 years are at high risk for clinically important fracturedislocation only if the mechanism of injury involves substantial force (i.e., a fall greater than their own height, a sport injury, an assault or a motor vehicle collision). Patients 40 years of age or older are at high risk only in the presence of humeral ecchymosis or after their first dislocation. Projected use of the rule would reduce the absolute number of prereduction radiographs by 27.9% and of postreduction by 81.9%. Conclusion: The Quebec shoulder dislocation rule for patients with acute anterior glenohumeral dislocation holds promise to reduce unnecessary imaging, pending validation. RÉSUMÉObjectif : Notre étude visait à établir de façon prospective une règle de décision clinique afin de guider le recours aux radiographies précédant et suivant la réduction chez les patients se présen-tant à l'urgence avec une luxation glénohumérale antérieure. Méthode : Cette étude de dérivation sur une cohorte prospective s'est déroulée sur une période de 3 ans, dans 4 services d'urgence d'hôpitaux universitaires. Nous avons inscrit des patients consentants de 18 ans ou plus qui présentaient une luxation glénohumérale antérieure. Nous avons comparé les patients ayant une luxation ou une fracture cliniquement importante avec ceux qui avaient une luxation sans complication en vue d'établir les critères d'une règle de décision clinique ORIGINAL RESEARCH • RECHERCHE ORIGINALE EM ADVANCES

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Section: Discussionmentioning

confidence: 99%

Refinement of the Quebec decision rule for radiography in shoulder dislocation

Émond

Sage

Lavoie

et al. 2009

CJEM

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“…Standard radiographs for the evaluation of shoulder injuries include an antero-posterior scapular view, and either an axillary or lateral scapular Y view (4,10). Retrospective examination of the shoulder films revealed subcoracoid subluxation of the humeral head with the superior aspect of the humeral head in apposition with the inferior glenoid rim.…”

Section: Discussionmentioning

confidence: 99%

Locked anterior-inferior shoulder subluxation presenting as luxatio erecta

Goldstein

Eilbert

2004

The Journal of Emergency Medicine

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“…Shoulder dislocates either in anterior, posterior or inferior direction with anterior dislocation as the commonest type accounting for nearly 96%. 1 Anterior dislocation is further sub-divided into sub coracoid, sub glenoid, sub clavicular and intrathoracic types with sub coracoid as the commonest. 2 The mode of injury is mostly by a fall onto an outstretched arm or by direct force over the posterior aspect of humeral head.…”

Section: Introductionmentioning

confidence: 99%

A simple innovative Chennai handshake technique for reducing anterior dislocation of shoulder joint: a community study of 60 cases

et al. 2017

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Background: Anterior shoulder dislocation is one of the commonest dislocation of our body. We here by introduce a simple, safe, successful and easily reproducible “Chennai Handshake Technique” to relocate anterior dislocation of shoulder joint.Methods: This method was performed by a single surgeon on sixty cases (51 males, 9 females) of anterior shoulder dislocation with a mean age of 38 years (18 to 58 years) between 2008 to 2013 in tertiary care center. Among sixty patients, there were 12 cases (20%) of fresh dislocation and 48 cases (80%) of recurrent dislocation. It comprises of holding the hand in a classical double shake position and then giving a gentle longitudinal traction (stage I) followed with slow abduction and external rotation of arm (stage II), thus reducing the shoulder dislocation. Vertical oscillation may be a part of stage II in some cases before the external rotation.Results: The index time of patient presenting to the casualty ranged from one hour to 18hrs with a mean of 4.45 hrs. The reduction time ranged from 1 to 16 min with a mean of 5.6 min. 17 dislocations (28.3%) were reduced during stage I. 41 dislocations (68.3%) were reduced during stage II. 5 dislocations (12.1%) needed vertical oscillation during stage II. we failed in two cases (3.3%).Conclusions: No need of assistant, no need of anesthesia, no complications makes this technique, a more look back one.

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Emergency Department Evaluation and Treatment of the Shoulder and Humerus

Cited by 45 publications

References 29 publications

Refinement of the Quebec decision rule for radiography in shoulder dislocation

Refinement of the Quebec decision rule for radiography in shoulder dislocation

Locked anterior-inferior shoulder subluxation presenting as luxatio erecta

A simple innovative Chennai handshake technique for reducing anterior dislocation of shoulder joint: a community study of 60 cases

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