Williams Stefanie E, Hackett Anthony J, Jensen Christian, Riddle Mark L
Department of Internal Medicine, Madigan Army Medical Center, 9040A Jackson Ave, JBLM, Tacoma, WA.
Department of Emergency Medicine, Carl R. Darnall Army Medical Center, 36065 Santa Fe Ave, Fort Hood, TX.
Mil Med. 2019 Mar 1;184(3-4):e302-e305. doi: 10.1093/milmed/usy133.
Posterior shoulder dislocation should be considered in the differential diagnosis of acute shoulder pain and immobility following trauma. Although far less common then the anterior dislocation, it is associated with high rates of comorbidity. Seventy-nine percent of posterior shoulder dislocations are missed on initial presentation, which is partially responsible for the high rate of comorbidity associated with these injuries. The mechanism of injury is varied from generalized seizure to minor trauma, which adds to the complexity of the diagnosis. There is a well-documented "vulnerable position" described as injury to the arm while it is in a flexed, adducted, and internally rotated position that is highly associated with posterior shoulder dislocation. The plain film scapular Y is the most clinically significant imaging and can be used alone to diagnose the injury, although ancillary imaging such as magnetic resonance imaging is often warranted. Once this rare condition has been diagnosed, there are a number of appropriate reduction techniques available to the health care provider. Presented here is a case of posterior shoulder dislocation that occurred while doing pushups for routine morning physical training. Also discussed are keys to recognition and treatment as well as a brief discussion of associated complications of the injury.
在创伤后急性肩部疼痛和活动受限的鉴别诊断中，应考虑后肩关节脱位。虽然它远不如前脱位常见，但它与高合并症发生率相关。79%的后肩关节脱位在初次就诊时被漏诊，这部分导致了与这些损伤相关的高合并症发生率。损伤机制从全身性癫痫发作到轻微创伤各不相同，这增加了诊断的复杂性。有充分记录的“易损位置”是指手臂处于屈曲、内收和内旋位置时受伤，这与后肩关节脱位高度相关。普通X线肩胛骨Y位片是临床上最重要的影像学检查，虽然通常需要磁共振成像等辅助影像学检查，但它可单独用于诊断损伤。一旦诊断出这种罕见情况，医疗保健提供者有多种合适的复位技术可用。本文介绍了一例在进行日常晨练俯卧撑时发生的后肩关节脱位病例。还讨论了识别和治疗的关键以及对该损伤相关并发症的简要讨论。
