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Prereduction radiographs in clinically evident anterior shoulder dislocation.
M Shuster1, R B Abu-Laban, J Boyd
1Department of Emergency Medicine, Mineral Springs Hospital, Banff, Alberta, Canada.
The American Journal of Emergency Medicine
|December 22, 1999
Summary
Experienced emergency physicians can reliably diagnose anterior shoulder dislocations clinically. Prereduction radiographs in these cases delay treatment without changing patient management, suggesting they are often unnecessary for confirmed dislocations.
Area of Science:
- Emergency Medicine
- Orthopedic Surgery
- Radiology
Background:
- Anterior shoulder dislocation is a common emergency department presentation.
- The utility of prereduction radiographs in suspected shoulder dislocations is debated.
- Clinical assessment by experienced physicians may obviate the need for imaging.
Purpose of the Study:
- To determine if experienced emergency physicians can identify patients with anterior shoulder dislocation where prereduction radiographs do not alter management.
- To assess the diagnostic accuracy of clinical examination for anterior shoulder dislocation.
- To evaluate the impact of prereduction radiographs on treatment time.
Main Methods:
- Prospective study of 97 patients with possible shoulder dislocation.
- Evaluation conducted at ski-hill clinics and a rural emergency department.
- Comparison of clinical diagnosis certainty with radiographic findings and management decisions.
Main Results:
- Emergency physicians were certain of dislocation by clinical exam in 67.8% of cases.
- All clinically diagnosed dislocations were confirmed.
- Prereduction radiographs did not alter management in confirmed cases.
- Radiographs added an average of 29.6 minutes to treatment.
Conclusions:
- Anterior shoulder dislocation is often accurately diagnosed through history and physical examination alone.
- For experienced physicians certain of the diagnosis, prereduction radiographs delay treatment and do not change management.
- Routine prereduction radiography may be unnecessary in confirmed anterior shoulder dislocations.