Emergency Cases Northwest Group

029 Light Bulb Moment

Situation

Light bulb sign on shoulder x-ray: but it wasn’t a posterior shoulder dislocation.

Background

32 year old lady sent to resus: fall, swollen and painful shoulder. Light bulb sign on shoulder x-ray: asked to sedate and reduce posterior shoulder dislocation . It didn’t feel dislocated and the arm was held in internal rotation. After more analgesia an axial view x-ray performed: shoulder was actually in joint. Discharged to fracture clinic, no reduction needed.

Assessment

If a shoulder x-ray is done with the arm in internal rotation the humeral head can resemble a light bulb, just like in a posterior dislocation. The additional axial view confirmed there was no actual dislocation.

Recommendation

In a suspected posterior shoulder dislocation, if the clinical exam doesn’t feel like a dislocation get additional views.

If you’re still unsure do a CT scan.
On the other hand if it looks and feels dislocated don’t do additional, unnecessary tests.

PLEASE DO NOT INCLUDE ANY PATIENT IDENTIFIABLE DATA OR GEO-LOCATION DATA IN THE SUBMISSION OR IN ANY ATTACHED IMAGES

Emergency Cases Northwest Group