Answer radER 1.2

radER Winners:

Dave Mishkin           Devon Moore

Chris Guyer              Rob Klever

Answer to Case 1.2

A 29-year-old man presents to your ED with left should pain that started immediately after he struck a volley ball during his serve. On exam, the left arm is held in slight abduction and external rotation. The patient is unable to touch his uninjured shoulder with the hand from his injured arm. His radiograph is seen below.

1. What two nerves are at greatest risk for injury?

2. How do you test the integrity of these potential nerve injuries?

3. What is a Hill-Sachs deformity?

Answers:

1. Axillary nerve and Muscultaneous nerve – injury may occur when the shoulder is dislocated or reduced

2. Axillary nerve

  • sensory loss over the lateral aspect of shoulder
  • weakness in shoulder abduction (deltoid)

Musculocutaneous nerve

  • weakness of forearm flexors and supinators
  • sensory loss over dorsum of forearm

3. Hill-Sachs deformity-compression fracture of the posterolateral aspect of the humeral head

  • results from impaction of humeral head on the anterior glenoid rim as it dislocates or reduces
  • occurs in up to 50% of anterior dislocations (more common in recurrent dislocators)

Thank you for everyone who submitted an answer. Please stay tuned for next week’s radER.

radER is a weekly contest consisting of a radiograph selected from various areas of emergency medicine that are central to the education of medical students and residents in training.

One Response

  1. Ax nerve–sens and motor deltoid
    MC Nerve–sens and motor forearm
    Hill-Sachs is a whop to the humeral head as it hits the glenoid during d/l or red. looks like a scoop out on Xray

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