Bark Derrick, Lewis Kelsey
Department of Research, Logan University, Chesterfield, Missouri, United States.
J Orthop Case Rep. 2023 Jul;13(7):60-64. doi: 10.13107/jocr.2023.v13.i07.3754.
Chronic unreduced shoulder dislocations (CUSDs) are rare with a prevalence of 0.10-0.18%, usually occurring after car crashes, falls, assaults, getting out of bed, and seizures. Management is often open reduction and fixation. Most cases have been reported in countries with inadequate resources and access to care often leading to misdiagnosis and poor management. We report a case of a patient with a CUSD presenting to a chiropractor within a federally qualified health center (FQHC).
A 55-year-old, Spanish-speaking, uninsured, female was referred from her primary care provider to a chiropractor within a FQHC with right shoulder pain and reduced range of motion. The patient reported two incidences of right shoulder dislocation, the first being a closed reduction 1 year before presentation and the second occurring 5 months before presentation without any management. Radiographs demonstrated an unreduced right anterior shoulder dislocation. The patient was referred to an orthopedist who treats patients on a sliding scale according to their income.
Because the patient was uninsured and did not have the necessary financial resources, she was unable to receive a shoulder reduction. These barriers often contribute to the misdiagnosis and increase morbidity associated with this pathology. Exercise therapy was not advised out of concern for further structural damage and neurovascular compromise. The recommended management is with topical pain creams and corticosteroid injections as directed by their primary care. Clinicians working with this population should be aware of the diagnosis, both typical and urgent features, complications, and the standard of care in this condition.
慢性未复位肩关节脱位（CUSDs）较为罕见，患病率为0.10 - 0.18%，通常发生在车祸、跌倒、袭击、起床及癫痫发作后。治疗通常为切开复位内固定。大多数病例报告来自资源匮乏的国家，由于获得医疗服务困难，常导致误诊和治疗不当。我们报告一例在联邦合格健康中心（FQHC）就诊于脊椎按摩师的CUSD患者。
一名55岁、讲西班牙语、未参保的女性患者，因右肩疼痛及活动范围受限，由其初级保健提供者转诊至FQHC的一名脊椎按摩师处。患者报告有两次右肩关节脱位，第一次是在就诊前1年进行了闭合复位，第二次发生在就诊前5个月，未进行任何处理。X线片显示右肩关节前脱位未复位。该患者被转诊至一名根据患者收入按比例收费的骨科医生处。
由于患者未参保且没有必要的经济资源，她无法接受肩关节复位治疗。这些障碍常常导致误诊，并增加与此病症相关的发病率。出于对进一步结构损伤和神经血管损伤的担忧，未建议进行运动疗法。建议的治疗方法是按其初级保健医生的指示使用局部止痛乳膏和皮质类固醇注射。治疗这类患者的临床医生应了解该病症的诊断、典型及紧急特征、并发症以及治疗标准。
