APPEARANCE

  • This is relatively uncommon.

  • Occurs with electrocution or seizures or direct blow to shoulders

  • The am is held adducted and internally rotated and the greater tuberosity if the humerus feels prominent

  • External rotation is painful and limited

 

MANAGEMENT

  • Give sufficient analgesics. Morphine with antiemetic like metoclopramide

  • XRAY the affected shoulder. Get and Anteroposterior and lateral view

  • On the AP view, look for the ‘light bulb sign due to internally rotated humerus displaying a globular head and for loss of parallelism between the humeral head and glenoid fossa

  • On the axillary lateral view look to the humeral head lying behind the glenoid

 

REDUCTION

  • Perform a reduction using midazolam intravenous and keep all resuscitation equipment ready

  • Apply traction to the arm and abduct to 90 degrees

  • Gently externally rotate the arm

  • After reduction, place the arm in a sling and repeat the X-ray to confirm.

  • If the reduction is unsafe, unstable refer to orthopaedic surgeons immediately

  • Refer the patient to fracture clinic and discharge on regular analgesics.

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