Article

Diagnosing anterior shoulder dislocation in the not-so-slim and obese: a novel examination technique

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  1. Blackburn S. Oxford dictionary of Philosophy, 2nd edition revised. New York, NY: Oxford Univ Press Inc; 2008.
  2. Harrington MM. The thin flat line; redefining who is legally dead in organ

donation after cardiac death. Issues Law Med 2009;25(2):95-143.

Diagnosing Anterior shoulder dislocation in the not-so-slim and obese: a novel examination techniqueB,BB

To the Editor,

The most common signs of an anterior shoulder dislocation in a patient are a visibly deformed shoulder that looks out of place and loss of the rounded contour of the deltoid, the latter which makes the shoulder look ftat or square. In the not-so-slim or obese patient, however, these signs may be absent (Fig. 1). We describe a novel sign to assist in the diagnosis of anterior Shoulder dislocations in this patient group. The patient in the depicted photograph (Fig. 1)

Fig. 1 A depression over the region of the left acromioclavicular joint as a red herring with the right shoulder being the injured one.

Fig. 2 Palpatation of the glenoid fossa in the same patient with an anterior right shoulder dislocation.

Fig. 3 Demonstration of a positive ‘glenoid sign’ in a slim patient.

was a 40-year-old man who presented with right shoulder pain after falling down. On clinical examination, inspection showed neither a deformed shoulder nor loss of the rounded contour of the right deltoid. However, palpation in the region of the humeral head with 2 fingers resulted in the ability to feel the glenoid fossa (Fig. 2). The asymmetry on deep palpation in comparison with the contralateral shoulder together with the feeling of the glenoid fossa is what we propose as “Shirley’s glenoid sign.” Although this sign is best used in the not-so-slim or obese patient, it is best seen in the slim (Fig. 3). From a teaching point of view, this sign may be useful to both emergency physicians as well as Orthopedic surgeons in cases where the known clinical signs of anterior shoulder dislocations are subtle or nonexistent, precluding a definitive diagnosis of the same.

Zubin J. Daruwalla MCh (Orth) Department of Orthopaedic Surgery National University Hospital Singapore 119074, Singapore

E-mail address: [email protected]

Shirley Ooi Beng Suat FRCS Ed (A&E) Department of Emergency Medicine National University Hospital Singapore 119074, Singapore

http://dx.doi.org/10.1016/j.ajem.2012.08.027

Emerging applications of low-dose ketamine for pain management in the EDB,BB

To the Editor,

The recent Institute of Medicine report, Relieving Pain in America: A Blueprint for Transforming Prevention, Care,

? Source(s) of support: Nil.

?? Confticts of interest: Nil.

? Prior presentations: None.

?? Funding sources: None.

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