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Resolution
The correct reading of the image is pseudosubluxation of the shoulder, which refers to inferior displacement of the humeral head relative to the glenoid by fluid in the joint cavity, either hemarthrosis or lipohemarthrosis. This is not a true dislocation.
The radiograph demonstrates a crescent-shaped, low density region representing fat layering above blood within the joint space. The humeral head is inferiorly displaced – but not dislocated – due to distension of the joint.
No fracture line was seen on this film.
Early follow-up with an orthopedist is important. Immediate management is a sling and ice.
Acknowledgement: Case presented by Nahum Kovalski, BSc, MDCM, Terem Emergency Medical Centers, Jerusalem, Israel.
Clinical Challenge: November, 2009
Nahum Kovalski, BSc, MDCM
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