Pediatric emergency medicine trisk 0859 0859
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fracture may mimic a shoulder dislocation. An AP, scapular “Y” view, and an
axillary view are preferred to show the position of the dislocation and the
presence of any fractures.
If the patient has a history consistent with dislocation but has more range of
motion than expected and the radiograph is normal, the patient may have
spontaneously reduced a dislocated shoulder or subluxated the glenohumeral joint
and only sprained the ligaments overlying the glenoid fossa. An apprehension test
may confirm the subluxation diagnosis (see Fig. 43.3 ).
Actual tears of the rotator cuff are uncommon before 21 years of age. However,
if the rotator cuff muscles are damaged or weak, the humeral head is displaced
upward during overhead motion. This may impinge the tendon of the
supraspinatus muscle and the subacromial bursa between the humeral head and
the acromion or coracoid process. Impingement symptoms usually occur with
repetitive overhead motions (e.g., throwing a ball). The pain is commonly notable
over the deltoid area though it may be poorly localized. There are several tests for
rotator cuff injuries that rely on fatiguing the secondary muscles and isolate the
rotator cuff muscles including Neer, Hawkins, and anterior impingement testing.
The painful arc test (see Fig. 43.4 ) has the best sensitivity and specificity. Plain
radiographs are usually normal, and magnetic resonance imaging is necessary to
diagnosis rotator cuff injuries but does not need to be done emergently.
