Prereduction radiographs in clinically evident anterior shoulder dislocation

The main study objective was to determine if experienced emergency physicia ns can accurately identify a subgroup of patients with anterior shoulder di slocation for whom prereduction radiographs do not alter patient management , Our prospective study evaluated 97 patients who presented to 2 ski-hill c linics and to our rural emergency department with possible shoulder disloca tion between November 1996 and May 1997, Emergency physicians were certain of shoulder dislocation by clinical examination alone in 40 of 59 cases (67 .8%) of possible dislocation, All 40 cases were found to have a dislocation (100%; 95% CI, 91.19% to 100%), and the prereduction radiograph did not af fect management of the injury, Prereduction radiographs added 29.6 +/- 12.6 8 minutes to treatment. We conclude that shoulder dislocation is often read ily apparent from history and physical examination, When the experienced em ergency physician is certain of the diagnosis of anterior shoulder dislocat ion, prereduction radiography delays treatment and does not alter managemen t. (Am J Emerg Med 1999;17:653-658. Copyright (C) 1999 by W.B. Saunders Com pany).