Logo

Log In Sign Up |  An official publication of: American College of Emergency Physicians
Navigation
  • Home
  • Multimedia
    • Podcasts
    • Videos
  • Clinical
    • Airway Managment
    • Case Reports
    • Critical Care
    • Guidelines
    • Imaging & Ultrasound
    • Pain & Palliative Care
    • Pediatrics
    • Resuscitation
    • Trauma & Injury
  • Resource Centers
    • mTBI Resource Center
  • Career
    • Practice Management
      • Benchmarking
      • Reimbursement & Coding
      • Care Team
      • Legal
      • Operations
      • Quality & Safety
    • Awards
    • Certification
    • Compensation
    • Early Career
    • Education
    • Leadership
    • Profiles
    • Retirement
    • Work-Life Balance
  • Columns
    • ACEP4U
    • Airway
    • Benchmarking
    • Brief19
    • By the Numbers
    • Coding Wizard
    • EM Cases
    • End of the Rainbow
    • Equity Equation
    • FACEPs in the Crowd
    • Forensic Facts
    • From the College
    • Images in EM
    • Kids Korner
    • Medicolegal Mind
    • Opinion
      • Break Room
      • New Spin
      • Pro-Con
    • Pearls From EM Literature
    • Policy Rx
    • Practice Changers
    • Problem Solvers
    • Residency Spotlight
    • Resident Voice
    • Skeptics’ Guide to Emergency Medicine
    • Sound Advice
    • Special OPs
    • Toxicology Q&A
    • WorldTravelERs
  • Resources
    • ACEP.org
    • ACEP Knowledge Quiz
    • Issue Archives
    • CME Now
    • Annual Scientific Assembly
      • ACEP14
      • ACEP15
      • ACEP16
      • ACEP17
      • ACEP18
      • ACEP19
    • Annals of Emergency Medicine
    • JACEP Open
    • Emergency Medicine Foundation
  • About
    • Our Mission
    • Medical Editor in Chief
    • Editorial Advisory Board
    • Awards
    • Authors
    • Article Submission
    • Contact Us
    • Advertise
    • Subscribe
    • Privacy Policy
    • Copyright Information

How to Use Point-of-Care Ultrasound to Identify Shoulder Dislocation

By Christine Riguzzi, MD; Daniel Mantuani, MD; and Arun Nagdev, MD | on February 12, 2014 | 1 Comment
Uncategorized
  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
Print-Friendly Version

Tips on using this imaging technique for the emergency physician

You Might Also Like
  • Ultrasound-Guided Glenohumeral Joint Evaluation and Aspiration
  • When to Use Point-of-Care Ultrasound for Skull Fractures
  • Tips for Emergency Physicians on Spotting Occult Knee Dislocation
Explore This Issue
ACEP Now: Vol 33 – No 02 – February 2014

Clinical Case

A 28-year-old male presents to the ED with moderate to severe right shoulder pain. The patient states that he fell while playing football with his friends and has 10/10 pain in his right shoulder. He has no other injuries, and the neurovascular exam of the affected extremity is normal.

You perform a point-of-care ultrasound examination of the affected shoulder and clearly see an anterior glenohumeral dislocation. Intravenous analgesia is administered, and the patient is moved to an appropriate bed for closed reduction.

Introduction

Shoulder (glenohumeral) dislocation is a common clinical presentation in the emergency department, comprising about 50 percent of all major joint dislocations.1 The large range of motion of the shoulder with minimal inferior tendinous support makes it prone to dislocation. Plain film radiography has been the imaging modality of choice for most clinicians when evaluating the ED patient with a suspected shoulder dislocation. Recent literature has demonstrated the superiority of point-of-care ultrasound (POCUS) in detecting both anterior and posterior shoulder dislocations, making it another rapidly evolving tool to improve accuracy, decrease error, and improve efficiency.2-4

Also, real-time ultrasonographic assessment of the articulation between the glenoid fossa and the humeral head is the ideal test when patients undergo procedural sedation for reduction. After shoulder manipulation, confirmation of the reduction attempt by plain film radiography incurs a delay that can prolong the length of stay. POCUS allows for a dynamic evaluation of the glenohumeral joint, immediately informing the clinician of a successful reduction or the need for additional shoulder manipulation without having to rely on plain film radiography.

Anatomy

The shoulder is composed of the bony articulation between the humeral head and the flat glenoid fossa that arises from the scapula. Anterior shoulder dislocations commonly occur when a large external force pushes the humeral head inferiorly below the glenoid fossa. Secondary contractions of the more powerful pectoralis and biceps muscles then pull the humeral head anteriorly, placing the humeral head just below the glenoid fossa or coracoid. Posterior shoulder dislocations are less common, representing only 2–5 percent of all dislocations, and are often missed during the initial patient presentation.5 Posterior shoulder dislocations are caused by forceful internal rotation and adduction of the shoulder, and classic mechanisms include seizures, trauma, and electrical shock. The posterior aspect of the shoulder is more stable than the anterior, making it less prone to dislocation. POCUS is an appealing and superior imaging alternative for the detection of both anterior and posterior dislocations.

POCUS allows for a dynamic evaluation of the glenohumeral joint, immediately informing the clinician of a successful reduction or the need for additional shoulder manipulation without having to rely on plain film radiography.

Ultrasound Evaluation of the Shoulder for Dislocation

We recommend the low-frequency (5-2 MHz) curvilinear transducer for this examination. While standing behind the affected shoulder, place the ultrasound system in front of the patient so that a clear view of the screen can be obtained (see Figure 1). If possible, ask the patient to adduct the humerus while supporting the elbow inferiorly for comfort. Palpate the scapular spine and follow it laterally toward the humerus (see also Figure 1). Place the probe parallel and just below the scapular spine with the probe indicator to the patient’s left, at the level of the glenoid. Adjust the depth until both the glenoid and humeral head are clearly seen (see Figure 2). The humeral head appears as a circular object located just lateral to the glenoid fossa. With the more common anterior dislocation, the humeral head will be deep on the screen (see Figure 3), while with a posterior dislocation, the humeral head will be closer to the probe and, therefore, more superficial on the screen (see Figure 4). If the shoulder is not dislocated, the patient should be able to internally and externally rotate the shoulder while adducted, and the rotational articulation between the humeral head and glenoid fossa will be seen clearly on the ultrasound screen.

Pages: 1 2 | Single Page

Topics: Critical CareEmergency MedicineEmergency PhysicianImaging and UltrasoundPractice Management. Procedures and SkillsTrauma and InjuryUltrasound

Related

  • Push-Dose Pressors in the Emergency Department

    June 29, 2025 - 1 Comment
  • 10 Essentials for Your Emergency Department Fanny Pack

    June 17, 2025 - 0 Comment
  • Case Report: Rapid Diagnosis of Acute Aortic Dissection with POCUS

    June 11, 2025 - 0 Comment

Current Issue

ACEP Now: July 2025

Download PDF

Read More

One Response to “How to Use Point-of-Care Ultrasound to Identify Shoulder Dislocation”

  1. March 17, 2014

    SonoStudy: Ultrasound for shoulder dislocation – Dx to anesthesia & reduction #FOAMed #FOAMus | SonoSpot: Topics in Bedside Ultrasound Reply

    […] ACEP News in 2/2014 had an article on shoulder dislocation by ultrasound – go here. […]

Leave a Reply Cancel Reply

Your email address will not be published. Required fields are marked *


*
*

Wiley
  • Home
  • About Us
  • Contact Us
  • Privacy
  • Terms of Use
  • Advertise
  • Cookie Preferences
Copyright © 2025 by John Wiley & Sons, Inc. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies. ISSN 2333-2603