Dislocated? POCUS improves clinical exam

The first patient had a shoulder injury and fairly unhelpful X-rays. POCUS revealed both Humeral heads to be in proper postition.

The second patient by history had a first dislocation which spontaneously reduced. He was feeling fine when I saw him. POCUS revealed a Hill–Sachs lesion confirming he had dislocated his shoulder and it was now in good postion. He had a seizure disorder but there was no documented seizure that morning.

[Editor’s note: POCUS can be helpful in determining if a shoulder is reduced during a procedure, particularly in large patients where surface landmarks are difficult to appreciate.  Be aware that it can be challenging to detect fractures in irregular surfaces such as the humeral and femoral heads.  Try to visualize the area in two planes and have a low threshold for confirmation by XRay/CT/MRI as appropriate.  One good site for images of Hill Sachs lesions can be found at the website Radiopaedia.org.]