Shoulder Pain after Seizure

A 45 year old male with known seizure history presented to the ED for evaluation after possible seizure activity in his home. After experiencing a tonic clonic seizure in the ED, the patient began to complain about right shoulder pain. Physical exam at this time revealed anterior fullness and pain with palpation of the right shoulder, and inability to abduct or flex the right arm at the right shoulder joint. Bedside ultrasound was used to accurate diagnose an anterior shoulder dislocation and aided in evaluation after reduction.

Bedside ultrasound has been shown to have a very high sensitivity, positive predictive value, and negative value for evaluating shoulder dislocations. One study showed ultrasound had a sensitivity of 100%, specificity of 80%, PPV of 98.7%, and NPV of 100%, while taking significantly less time than x ray to make a diagnosis (p<0.001)

Javad Seyedhosseini, Jaleh Saiidian, Amirpejman Hashemi Taheri, Elnaz Vahidi, Accuracy of point-of-care ultrasound using low frequency curvilinear transducer in the diagnosis of shoulder dislocation and confirmation of appropriate reduction, Turkish Journal of Emergency Medicine, 2017, ISSN 2452-2473, http://dx.doi.org/10.1016/j.tjem.2017.07.002

Eric Stern MD
PGY1 August 2017

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Danielle Hamilton
Danielle Hamilton
1 year ago

Is that the humeral head on the left & the scapula on the right?

Vi Dinh
Admin
1 year ago

Thanks for the comment! This case was a while ago and I wasn’t the attending on this case. However. couple of issues with this. Depth is not optimized for this study to see the shoulder bones. Also looks like from the annotation they were more looking at the muscles and not the bone. I can’t really tell from this image what the bony structures are. But yes I would have to assume that is the humeral head.

Danielle Hamilton
Danielle Hamilton
1 year ago
Reply to  Vi Dinh

Awesome! I’m glad that it wasn’t straightforward, because I was having some trouble identifying the structures. Hopefully we can get better views in the future for anterior & posterior shoulder dislocations so that I can make some MSK clinical correlates on this topic!

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