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.