AdultPediatric
Cannot miss / life threats
Cannot miss / life threats
Diagnostic flow — check first
Diagnostic flow — check first
- Trauma vs atraumatic? → if trauma, XR first.
- Atraumatic + ≥40 yo or risk factors → ECG + troponin to rule out referred MI.
- Fever + hot joint + refusal to move → aspirate.
- Tearing pain radiating to back → CTA chest.
Differential diagnosis — checklist
0/16
Check off each diagnosis as you consider it. Tap the name for unique exam, lab/imaging clues, first-line confirmatory test, and management.
Traumatic0/6
Atraumatic / overuse0/4
Infection / inflammatory0/2
Referred / cannot-miss0/4
Initial ED workup
Bedside0/5
- Full vitals
- Inspect for deformity, ecchymosis, skin tenting
- Assess axillary, radial, median, ulnar nerve function
- Check distal pulses, capillary refill
- ECG if any cardiac suspicion or pain ≥40 yo
Labs0/3
- CBC, CRP/ESR if infection suspected
- Troponin if cardiac risk
- Joint aspiration if effusion + fever
Imaging0/3
- AP + scapular Y + axillary XR for trauma/dislocation
- US or MRI (with & without contrast) outpatient for soft-tissue
- CTA chest if dissection suspected
Initial management0/4
- Sling, ice, analgesia (NSAID + acetaminophen ± opioid)
- Reduce dislocation under procedural sedation
- Emergent ortho consult for septic joint, open fracture, NV compromise
- Activate cath lab if STEMI
Pearls / pitfalls
Pearls
- Posterior dislocations are missed on AP alone — always get axillary or scapular Y.
- Always check axillary nerve sensation before and after reduction.
- Left shoulder pain with abdominal trauma = splenic injury until proven otherwise (Kehr sign).