2. A 25yo male complains of shoulder pain after falling
forward on his outstretched hand after leaving a club.
On exam, he holds his right arm internally rotated and
adducted
3. Light bulb sign: Humeral head looks rounded on AP view
and posterior to the glenoid fossa on axillary view
Empty glenoid sign: Increased distance between the
articular surface of humeral head and anterior glenoid
Normal range: 0-6mm
Through defect: Curved dense line, indicating impaction
fracture of the antero-medial surface of the humeral head
4. Closed reduction
Operative repair if closed reduction unsuccessful
Immobilization
Place in sling and swath
Obtain post reduction film
Physical therapy and early mobilization to prevent
frozen shoulder
Ortho follow up
Prognosis if often excellent if detected early but very
susceptible to reinjury and repeated dislocations if
detected late
5. History typically of axial load to the adducted and
internally rotated arm (fall on outstretched arm or blow to
the front of shoulder
Although the mechanism of fall on outstretched arm is
more common, test questions will often use a pt presenting
after a seizure or electrical shock
Only 20% abduction needed to obtain axillary view, but if
unable to obtain, use a scapular Y view
Associated with
Detachment of posterior glenoid labrum (reverse Bankhart)
Defect of the anteromedial aspect of the humeral head
(reverse Hill-Sachs)
Fractures of the humeral tuberosities, shaft, and/or humeral
neck.
6.
7.
8.
9. Marx J MD; Hockberger R MD; Walls R MD. Rosen’s
emergency medicine. 7th ed.
Simon R; Sherman S; Koenigsknecht S. Emergency
orthopedics: the extremities. 5th ed. McGraw Hill
Publishing.
Wheeless C R III MD. Wheeless textbook of
orthopedics. www.wheelessonline.com.
