Case Reviews from the Denver Health EM Residency

An innovative approach to pain management during shoulder relocation

A 34 y/o male presents to your emergency department with an obvious shoulder deformity after trying to wash his hair and hearing his shoulder “pop.” The patient has a past medical history of three shoulder dislocations in the last month. He was drinking alcohol last night and took off his arm sling to shower when the incident occurred. Exam reveals a shoulder deformity consistent with a left anterior shoulder dislocation, confirmed by radiograph. Besides conscious sedation, what other method could you use to provide anesthesia for shoulder relocation?

See next page for case conclusion.



# Another complication of interscalene blockAaron Johnston 2011-11-22 09:36
I have seen this method of anaesthesia advocated for patients who are poor candidates for sedation because of respiratory problems, and I think this is misguided. The interscalene block is in close proximity to the phrenic nerve and frequently results in diaphragmatic paresis due to phrenic nerve block. Diaphragmatic paresis can be catastrophic for patients with significant respiratory disease.

I personally think that diaphragmatic paresis due to inadvertent phrenic nerve block should always be included in the complications of interscalene block, and that caution should be exercised in using this block in patients with respiratory disease or compromise.

Aaron Johnston
# Hematoma block much easier.Michael Mudrey, D.O. 2011-11-23 11:25
In my small community hospital where US is rarely available and the hospital cannot afford a bedside machine, I find it very helpful to do an intrarticular injection. The trick is waiting at least 20 mins for full effect. It's worked many times for me!
# What about intra-articular injection/Adan 2012-04-29 13:40
I have been reducing shoulder dislocations after injecting 5-7 ml of lido or bupi into the shoulder joint. It is easy as the humeral head is out of the way, just point directly to the glenoid fossa, inject, wait 5 mins, reduce dislocation, done.

Add comment

Security code

Popular Authors

  • Greg Henry
  • Rick Bukata
  • Mark Plaster
  • Kevin Klauer
  • Jesse Pines
  • David Newman
  • Rich Levitan
  • Ghazala Sharieff
  • Nicholas Genes
  • Jeannette Wolfe
  • William Sullivan
  • Michael Silverman

Subscribe to EPM