Type Ib (subcoracoid variant) case presentation
Type Ib case
This section will walk you step by step through how to assess and manage a subcoracoid variant case
What matters for every case?
Patient factors - young, fit and healthy in this case
Position - can the patient adduct?
What type of injury is this? - let's find out
What clinical features are you looking for?
What clinical features are you looking for?
Type Ib (subcoracoid variant) case presentation
XRAY
This shows an AP film that looks like the humeral head is sitting in a subcoracoid position. There are a couple of screws from a previous repair (operative scar anterior to shoulder matches this, as does the history from the patient). The lateral XR confirms the humeral head is sitting anterior to the glenoid rim.
Is there an obvious acromial step?
Yes, and it looks and feels large (greater than one finger-breadth)
Is there a fullness?
Is there a fullness?
There is a fullness visible and palpable anterior to the shoulder. This is the humeral head and fits with a Type II (subcoracoid) rather than a Type II (subglenoid) dislocation where the fullness would be felt in the axilla.
Type Ib (subcoracoid variant) case presentation
Can he adduct?
No - this patient is very uncomfortable, has lots of spasm, and is unable to adduct. In this picture you can see his torso slumped over to the left, and a large scapulo-humeral angle on XRay.
IGIANV?
The IGIANV is <44mm which fits with a Type I injury.
We don't have a front on view of this patient to estimate apparent arm length asymmetry (or to be precise, apparent acromion to olecranon length asymmetry)
Our Team
Our Team
This is a Type Ib presentation. We will need to remove the muscle spasm and then reassess. The expectation is that this patient will then be able to be placed into the Analgesic position 1, effectively having been converted to a Type Ia. This is the starting point for adduction manoeuvres.
Type Ib (subcoracoid variant) case presentation
Does this patient need drugs?
Yes, he does.
This is a Type Ib presentation. We will need to remove the muscle spasm and then reassess. The expectation is that this patient will then be able to be placed into the Analgesic position 1, effectively having been converted to a Type Ia. This is the starting point for adduction manoeuvres.
Video demonstration
This video will show you the point from which the patient returns to XRay through to reduction.
Patient centred approach
Use the algorithm to help you plan and individualise care for the patient in front of you.