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Any fracture or dislocation
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Left Anterior Shoulder Dislocation
Patient: Sanu Shisha, 18 yrs/HM | View: Left Shoulder Joint AP | Date: 16-07-2026
Primary Finding: Anterior Glenohumeral Dislocation
The humeral head is completely displaced out of the glenoid fossa. It is sitting medially and inferiorly below the coracoid process - this is the classic subcoracoid anterior dislocation, the most common type of shoulder dislocation (accounting for ~95% of all shoulder dislocations).
Key radiographic sign: The normal "ball-in-socket" relationship between the humeral head and the glenoid is lost. The humeral head is no longer overlapping the glenoid on the AP view.
Associated Injuries to Rule Out
| Injury | Description | How to Detect |
|---|---|---|
| Hill-Sachs lesion | Posterolateral humeral head impaction fracture | Post-reduction X-ray / CT |
| Bony Bankart lesion | Fracture of anterior-inferior glenoid rim | Post-reduction X-ray / CT |
| Greater tuberosity fracture | Avulsion with rotator cuff pull | Visible on AP or post-reduction views |
| Axillary nerve injury | Neuropraxia causing deltoid weakness | Clinical exam post-reduction |
On this single pre-reduction AP view, no large displaced fracture of the clavicle, proximal humerus, or scapula is visible. The AC joint and ribs appear intact.
Immediate Management
- Closed reduction under adequate analgesia/sedation (Cunningham, Stimson, or Kocher technique)
- Post-reduction AP + axillary/Y-view X-rays to confirm concentric reduction and detect occult fractures
- Neurovascular check before and after reduction (axillary nerve - lateral deltoid sensation; axillary artery)
- Immobilization in a sling for 2-3 weeks
- Physiotherapy afterward to reduce recurrence risk (recurrence rate in young patients <20 yrs is up to 90%)
Note: At 18 years of age, this patient is in the highest-risk group for recurrent anterior instability. Surgical stabilization (Bankart repair) may be considered if recurrences occur. Post-reduction CT is advisable to rule out bony lesions given the young age.
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