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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