The Utilization Of Musculoskeletal Ultrasonography In A Patient With Shoulder Pain - Page #1

Author: Benjamin Boswell, DO
Co Author #1: Michael Rosselli, MD

Patient Presentation:
A 63 year old right hand dominant male presents to the Emergency Department with chief complaint of acute onset, moderate, constant, dull left shoulder pain that began 1 month ago after falling from his bed. The pain is exacerbated by movement of his left upper extremity and palpation of the left shoulder. The pain is alleviated by adducting his left arm and holding it motionless.
Associated Symptoms: Decreased movement, mild swelling, deformity
Symptoms Not Associated: Paresthesias, weakness, back pain, chest pain, or elbow pain.

Prior History: Patient presented to the emergency department 2 weeks earlier with the same complaint and was diagnosed with a posterior shoulder dislocation. Reduction was attempted and presumed successful, with post reduction x-rays. Patient was subsequently discharged home with orthopedic follow-up. During his follow-up evaluation, the patient was told that he likely had a posterior shoulder dislocation, prompting the patient to re-present to the emergency department.
PSHx: None
PFHx: Non-contributory
Medications: Crestor, Aspirin, Metoprolol
Allergies: NKDA
Review of Symptoms: Postive for left shoulder pain

Physical Exam:
Musculoskeletal (Left Upper Extremity): No skin changes present, TTP posterior shoulder, AC joint. active and passive ROM limited on abduction, internal rotation, external rotation, flexion, and extension. Gross sensation intact to badge area and distal extremity. Radial, median, and ulnar nerves intact at hand. 2+ radial/ulnar pulses. Cap refill <2 sec.
Remainder of Physical Exam Unremarkable.

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