A 25-year-old male presented with shoulder pain after falling forward on his outstretched hand. X-rays showed a humeral head that was rounded and posterior to the glenoid fossa, indicating a posterior shoulder dislocation. There was also an increased distance between the humeral head and glenoid, known as the empty glenoid sign. A curved dense line on the x-ray suggested an impaction fracture of the anteromedial humeral head. Treatment options included closed reduction, operative repair if closed reduction failed, immobilization, physical therapy, and follow up to address the posterior shoulder dislocation and fracture.

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.

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.