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Elderly woman with post-traumatic locked shoulder
  1. S A Mann1,
  2. J M Leith2,
  3. J H White2,
  4. B B Forster2
  1. 1
    University of Saskatchewan, Canada
  2. 2
    University of British Columbia, Canada
  1. Dr B B Forster, Department of Radiology, University of British Columbia Hospital, 2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5; bruce.forster{at}vch.ca

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CASE HISTORY

A 60-year-old woman presented to an orthopaedic surgeon with a painless but very stiff right shoulder after an injury sustained from a fall 4 months earlier while on vacation. She was right-hand dominant. She had presented to the emergency department 1 day after directly landing on her shoulder, in considerable pain and unable to move the arm. At the time, she was assessed by an emergency physician and radiographs were obtained, which were interpreted as normal. She was discharged home with instructions to follow up with her family doctor.

Her family doctor referred her to physiotherapy, with poor results. A subsequent ultrasound was limited due to the patient’s inability to move the arm. The patient was eventually referred to the orthopaedic surgeon, approximately 4 months after the injury. The surgeon noted global wasting of the deltoid and rotator cuff muscles of the right shoulder. The patient had an internal rotation contracture and could not externally rotate. The arm could not be abducted. She could elevate the shoulder forward to approximately 80 degrees. Her rotator cuff power as best could be determined appeared to be intact. The initial radiographs taken 4 months earlier were reviewed (figs 1–3).

Figure 1

Anteroposterior radiograph of the right shoulder.

Figure 2

Transscapular radiograph of the right shoulder.

Figure 3

Axillary radiograph of the right shoulder.

QUESTION

What is your diagnosis based on these plain radiographs?

See page 231 for the answer.

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Footnotes

  • Competing interests: None.

  • Patient consent: Obtained.

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