Bedside ultrasonography for verification of shoulder reduction: A long way to go / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>Shoulder dislocation is a common joint dislocation managed by the emergency physicians in the emergency departments. Pre- and post-reduction radiographic examinations have long been the standard practice to confirm the presence of dislocation and the successful reduction. However, shoulder ultrasonography has recently been proposed as an alternative to the radiographic examination. This study aimed to assess the accuracy of ultrasonography in evaluating proper reduction of the dislocated joint.</p><p><b>METHODS</b>This was a prospective observational study. All patients with confirmed anterior shoulder dislocation were examined by both ultrasonography and radiography after the attempt for reduction of the dislocated joint. The examiners were blinded to the result of the other imaging modality. Results of the two methods were then compared.</p><p><b>RESULTS</b>Overall, 108 patients with confirmed anterior shoulder dislocation were enrolled in the study. Ninety-one (84.3%) of the patients were males. Mean age of the participants was (30.11 ± 11.41) years. The majority of the patients had a recurrent dislocation. Bedside ultrasonography showed a sensitivity of 53.8% (95% CI: 29.1%-76.8%) and a specificity of 100% (95% CI: 96.1%-100%) in detecting inadequate reductions. The results of ultrasonography had a statistically significant agreement with the results of radiography (Kappa = 0.672, p < 0.001).</p><p><b>CONCLUSION</b>The results suggest that the sensitivity of post-reduction ultrasound is not sufficient for it to serve as a substitute for radiography.</p>

Sonography as a new modality in the management of shoulder dislocation

The need for both pre- and post-reduction radiographs has recently been questioned when treating shoulder dislocation. Several case reports and case series have suggested that ultrasonography might be useful bedside diagnostic modality for evaluating shoulder dislocation. The purpose of this review was to evaluate studies that questioned necessity of radiographs for shoulder dislocation and also studies that evaluated bedside ultrasound as an alternative modality in shoulder dislocation. Ultrasonography can be used in patients with suspected shoulder dislocation. It cannot replace radiography because of possible associated fractures but it can be used before and after reduction to confirm successful relocation to reduce the risk of repeated sedation. It can also increase the certainty of physicians in cases that shoulder dislocation management needs to be performed without X-ray assessmen