Cases - shoulder
Wedged Subglenoid
If you can feel the scapula move in rigid tandem with any movements of the humerus once you are in an abducted position, and your patient is relaxed and cooperative, then you have a case where the head is wedged under the glenoid rim. When you attempt abduction, external rotation or anterior/posterior you will feel the scapula move as if it is stuck to the humeral head. Either sedate see if removal of all muscle spasm is the issue, or try an alternative approach.
Move the humerus into a forward (anterior) elevation position while an assistant keeps the tip of the scapula pushed medially. This allows the head to dislodge from the wedged position and either reduces immediately, or moves into a more free sub-glenoid position where you can re-attempt a zero position.
The other option is formally moving your patient into a prone position and performing scapula manipulation.
Fracture fragments in the way
On the way
Subcoracoid with spasm
Looks cooperative but...
On the way
Looks cooperative but...
Looks cooperative but...
Looks cooperative but...
OOn the way
Spasm - SC variant
Looks cooperative but...
Spasm - SC variant
On the way
SG variant
Looks cooperative but...
Spasm - SC variant
On the way
wedged subglenoid
Moving from zero to hero
Here’s a tip for knowing when your zero position isn’t working and you need to try a different approach. If you can feel the scapula move in rigid tandem with any movements of the humerus once you are in an abducted position, and your patient is relaxed and cooperative, then you have a case where the head is wedged under the glenoid rim. Attempted movements include further abduction, external rotation or anterior/posterior, and you will feel the scapula move as if it is stuck to the head. You are unlikely to be able to coax the head into sliding out and will need to either sedate your patient and see if removal of all muscle spasm is the issue, or try an alternative approach. Moving the humerus into a forward (anterior) elevation position while an assistant keeps the tip of the scapula pushed medially, allows the head to dislodge from the wedged position and either reduce immediately, or move into a more free sub-glenoid position where you can re-attempt a zero position. The other option is formally moving your patient into a prone position and performing scapula manipulation. The take home message is that if you are stuck – stop, reassess why you are stuck, use the additional information you have gained based on your first attempt to be flexible and alter your plan.