scholarly journals Accuracy of Landmark-guided Glenohumeral Joint Injections as Assessed by Ultrasound in Anterior Shoulder Dislocations

2021 ◽  
Vol 22 (6) ◽  
pp. 1335-1340
Author(s):  
Talib Omer ◽  
Michael Perez ◽  
Kristen Berona ◽  
Chun Nok Lam ◽  
Dana Sajed ◽  
...  
Keyword(s):  
Shoulder Dislocation ◽  
Trauma Center ◽  
Ultrasound Guidance ◽  
Glenohumeral Joint ◽  
Point Of Care ◽  
Tertiary Care ◽  
Point Of Care Ultrasound ◽  
Anterior Shoulder Dislocation ◽  
Pain Scores ◽  
Joint Injections

Introduction: To determine the accuracy of landmark-guided shoulder joint injections (LGI) with point-of-care ultrasound for patients with anterior shoulder dislocations. Methods: Patients with anterior shoulder dislocations who underwent LGI were enrolled at our tertiary-care and trauma center. LGI attempts were recorded by an ultrasound fellowship-trained ED physician who determined if they were placed successfully. Pain and satisfaction scores were recorded. Results: A total of 34 patients with anterior shoulder dislocation and their treating ED physicians were enrolled. 41.1% of all LGI were determined to be misplaced (n=14). Patients with successful LGI had a greater decrease in mean pain scores post-LGI. Conclusions: LGI had a substantial failure rate in our study. Using ultrasound-guidance to assist intra-articular injections may increase its accuracy and thus reduce pain and the need for subsequent procedural sedation.

scholarly journals Just the Facts: Point-of-care ultrasound in the management of shoulder dislocations

CJEM ◽  
2020 ◽  
Vol 22 (3) ◽  
pp. 287-290
Author(s):  
Ryan Henneberry ◽  
Tara Dahn ◽  
Paul Atkinson
Keyword(s):  
Emergency Department ◽  
Range Of Motion ◽  
Shoulder Pain ◽  
Shoulder Dislocation ◽  
Point Of Care ◽  
Left Shoulder ◽  
Point Of Care Ultrasound ◽  
Posterior Shoulder Dislocation ◽  
Posterior Shoulder

A 59-year-old man presents with left shoulder pain after falling while playing with his dog at the park. He drove himself to the emergency department (ED). He reports 5/10 pain and has reduced range of motion of the shoulder. His shoulder looks normal on exam and is not squared off. You wonder if he might have a posterior shoulder dislocation.

scholarly journals Point of Care Ultrasound First: An Opportunity to Improve Efficiency for Uncomplicated Pregnancy in the Emergency Department

POCUS Journal ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 42-44
Author(s):  
Sara Urquhart ◽  
Kendall Stevens ◽  
Mariah Barnes ◽  
Matthew Flannigan
Keyword(s):  
Emergency Department ◽  
Random Sample ◽  
Medical Center ◽  
Point Of Care ◽  
Tertiary Care ◽  
Radiology Department ◽  
Point Of Care Ultrasound ◽  
Tertiary Care Medical Center ◽  
Time To Diagnosis ◽  
Emergency Department Patients

Introduction: Research suggests emergency providers using point-of-care ultrasound (POCUS) to confirm an uncomplicated intrauterine pregnancy (IUP) can decrease emergency department (ED) length of stay (LOS) compared to a radiology department ultrasound (RADUS). The objective of this study was to compare the time to diagnosis and LOS between POCUS and RADUS patients. Methods: This was a retrospective study at one urban medical center. A standardized tool was used to abstract data from a random sample of pregnant patients diagnosed with uncomplicated IUP between January 2016 and December 2017 at a single tertiary care medical center. Microsoft Excel 2010 software was used to measure time intervals, prepare descriptive statistics, and perform Mann-Whitney U tests to compare differences. Results: A random sample of 836 (36%) of the 2,346 emergency department patients diagnosed with an IUP between 8-20 weeks’ gestation during the study period was evaluated for inclusion. Three hundred sixty-six met inclusion criteria and were included in the final analysis. Patients were divided into 2 groups based on which type of ultrasound scan they received first: POCUS (n=165) and RADUS (n=201). Patients who received POCUS were found to have an IUP identified in an average of 48 minutes (95% CI, 43 to 53), while the RADUS group’s mean time to diagnosis was 120 minutes (95% CI 113 to 127) with a difference of 72 minutes (95% CI, 63 to 80; p<0.001). The mean LOS for patients who received POCUS was 132 minutes (95% CI, 122 to 142), while that of the RADUS group was 177 minutes (95% CI 170 to 184) with a difference of 45 minutes (95% CI 32 to 56; p<0.001). The study is limited by its single-center, retrospective design and by lack of blinding of data abstractors. Conclusion: Pregnant emergency department patients diagnosed with an uncomplicated IUP between 8-weeks and 20-weeks’ gestation had statistically significant reduction in time to diagnosis and disposition from the ED if assessed with POCUS as compared to RADUS.

scholarly journals A simple innovative Chennai handshake technique for reducing anterior dislocation of shoulder joint: a community study of 60 cases

2017 ◽  
Vol 3 (6) ◽  
pp. 1084
Author(s):  
Muhammad Thahir ◽  
B. Suresh Gandhi ◽  
Kalaivanan Kanniyan ◽  
Shanmugasundaram .
Keyword(s):  
Shoulder Joint ◽  
Shoulder Dislocation ◽  
External Rotation ◽  
Care Center ◽  
Tertiary Care ◽  
Stage I ◽  
Stage Ii ◽  
Anterior Dislocation ◽  
Vertical Oscillation ◽  
Anterior Shoulder Dislocation

<p class="abstract"><strong>Background:</strong> Anterior shoulder dislocation is one of the commonest dislocation of our body. We here by introduce a simple, safe, successful and easily reproducible “Chennai Handshake Technique” to relocate anterior dislocation of shoulder joint.</p><p class="abstract"><strong>Methods:</strong> This method was performed by a single surgeon on sixty cases (51 males, 9 females) of anterior shoulder dislocation with a mean age of 38 years (18 to 58 years) between 2008 to 2013 in tertiary care center. Among sixty patients, there were 12 cases (20%) of fresh dislocation and 48 cases (80%) of recurrent dislocation. It comprises of holding the hand in a classical double shake position and then giving a gentle longitudinal traction (stage I) followed with slow abduction and external rotation of arm (stage II), thus reducing the shoulder dislocation. Vertical oscillation may be a part of stage II in some cases before the external rotation.<strong></strong></p><p class="abstract"><strong>Results:</strong> The index time of patient presenting to the casualty ranged from one hour to 18hrs with a mean of 4.45 hrs. The reduction time ranged  from 1 to 16 min with a mean of  5.6 min. 17 dislocations (28.3%) were reduced  during stage I. 41 dislocations (68.3%) were reduced during stage II. 5 dislocations (12.1%) needed vertical oscillation during stage II. we failed in two cases (3.3%).</p><p><strong>Conclusions:</strong> No need of assistant, no need of anesthesia, no complications makes this technique, a more look back one.</p>

Biomechanical Effects of Failure Modes in Repeated Anterior Inferior Glenohumeral Joint Dislocations

2002 ◽  
Author(s):  
Thay Q. Lee ◽  
Bruce Y. Yang ◽  
James E. Tibnoe ◽  
Patrick J. McMahon
Keyword(s):  
Surgical Treatment ◽  
Shoulder Dislocation ◽  
Failure Modes ◽  
Glenohumeral Joint ◽  
Anterior Shoulder Dislocation ◽  
Joint Forces ◽  
Joint Dislocations ◽  
Precise Quantification

Accurate and precise quantification of the failure modes and repair methods for anterior inferior glenohumeral joint dislocations are very important for effective surgical treatment of the shoulder. The purpose of this study was to quantitatively assess the effects of failure modes and repair strength by measuring the differences in glenohumeral translation and joint forces prior to and following repeated anterior shoulder dislocation and repair.

scholarly journals P013: A new efficient and accurate scanning protocol for traumatic pneumothorax

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S67
Author(s):  
A. Bignucolo ◽  
C. Acton ◽  
R. Ohle ◽  
S. Socransky
Keyword(s):  
Ct Scan ◽  
Point Of Care ◽  
Data Extraction ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Point Of Care Ultrasound ◽  
Evidence Based ◽  
Left Hemithorax ◽  
Scanning Protocol ◽  
Scanning Area

Introduction: According to the International Evidence-Based Recommendations for Point-of-Care Lung Ultrasound published in 2012, the sonographic technique for evaluating a patient for a pneumothorax (PTX) “consists of exploration of the least gravitationally dependent areas progressing more laterally” in the supine patient. However, there is a wide variety of scanning protocols in the literature with varying accuracy and complexity. We sought to derive an efficient and accurate scanning protocol for diagnosing pneumothorax using point of care ultrasound in trauma. Methods: We performed a retrospective chart review of a tertiary care trauma registry from Nov 2006 to Aug 2016. We included patients with a PTX diagnosed on computed tomography (CT). Patients were excluded if they did not have an identifiable PTX on the CT scan or if they underwent a tube thoracostomy prior to the CT scan. Penetrating and blunt trauma were eligible. Data were extracted with a standardized data collection tool and 20% of charts reviewed by two reviewers. Pre defined zones were used to map area of PTXs on CT. Sensitivity, specificity and 95% CI are reported for presence of PTXs in each individual or combination of lung zones as identified on CT scan. Results: Data were collection yielded 170 traumatic PTX on chest CT with an average age of 44.2 and 77.8% male. The kappa for data extraction was 0.88. 19.4% of patients had bilateral PTX leading to a total sample size of 203. The average ISS score was 20.7 and 93% of patients survived to discharge. The length of ICU stay and hospital stay was 3.7 and 11.2 days respectively. The most accurate and efficient protocol would involve scanning the inferior border of the clavicle at the para-sternal border and again at the mid-clavicular line down to the cardiac (left hemithorax) and liver lung points (right hemithorax). The sensitivity of this scanning area in the detection of PTXs was 91.6% (95% CI 86.9-95%,). Limiting the area to the most anterior point of the chest wall increased the risk of missing a PTX (Sensitivity 89.7% (95%CI 84.6-93.5)). Conclusion: We have derived an evidence-based standardized accurate and efficient scanning protocol to rule out a pneumothorax on point of care ultrasound.

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