Accuracy of point-of-care ultrasonography for the diagnosis and management of shoulder dislocation in the emergency department: A literature review
Main Article Content
Abstract
The shoulder joint has dynamic articulation with a wide range of motion and mobility, making it more prone to common dislocations. Nearly half of all joint dislocations occur in the shoulder region, with most acute shoulder dislocations occurring in the anterior position (95%), followed by posterior dislocation (2%-5%) and rarely in the inferior region of the shoulder. The current standard approach in managing shoulder dislocations is to perform pre- and post-reduction via radiographs. Consequently, this can result in treatment delays, repeat exposure to radiation, multiple administration of sedatives in case of an unsuccessful reduction, and increased healthcare costs. Point-of-care ultrasound (POCUS) is a non-invasive diagnostic tool broadly applied in many medical and surgical fields. The emergency medicine literature contains several case reports detailing emergency physicians using POCUS to evaluate shoulder dislocations. In this literature review, the first objective is to compare different views on applying POCUS imaging and sonographic methods of diagnosing shoulder dislocation. The second objective is to determine the accuracy of this sonographic method in diagnosing shoulder dislocation by experienced and inexperienced sonographers in the Emergency department. Overall, POCUS had a 99.1% (95% CI, 84.9%–100%) sensitivity and 99.9% (95% CI, 88.9%–100%) specificity for diagnosing anterior shoulder dislocation. Furthermore, POCUS had a 99.0% (95% CI, 92.3%–99.9%) sensitivity and 99.7% specificity for diagnosing posterior shoulder dislocation. Implementation of POCUS in the clinical setting could serve as a method of developing hands-on ultrasound skills in medical school, suggesting possible future broader applicability of this skill in improving patient care. POCUS is an alternative diagnostic method for managing shoulder dislocations. However, further studies are needed before routine implementation.
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