Look for the Signs

​An AP image of a shoulder flashed up on the screen. My colleagues often bring me interesting, rare, difficult, and classic cases because I write this blog. All are intellectually stimulating cases that remind me of the exciting parts of being an EP. It's a challenge to see how many clues I can find to make the diagnosis. These short interactions also help me form stronger bonds with my colleagues, a bonus for my interest in wellness.​First, my eyes were drawn to the wide glenohumeral interval. The space is huge (yellow lines in photo below). The glenoid appeared vacant. It also showed the rim sign where the glenoid rim can be seen without overlap. The normal half-moon appearance of the superimposed glenoid and humeral head was gone.Next, the shape of the humeral head was wrong. It looked like a lightbulb when it should look like a club (blue circle).And the normally smooth Moloney's arch formed by the medial scapular border and down the humeral shaft had a point (purple inverted V). It should be a Romanesque arch, not a peaked Gothic one. Moloney's arch is just like the gently curved, continuous, contoured Shelton line in the hip. It wasn't right either.​Finally, there was a subtle "M" (red lines) made by the contours of the greater and lesser tuberosity in the internal rotation. This is a Mouzopoulus sign.​This must be a posterior dislocation.​The screen on the Y view confirmed that to be correct. The humeral head sat under the acromion (yellow circle) i...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs