ICEM Conference Pearls of Wisdom
POCUS Workshop Instructor Dr Allan Whitehead
1. Use a posterior approach for assessing for shoulder effusion, for aspiration, for assessing shoulder enlocation and for intra-articular injection for shoulder dislocation.
2. For shoulder dislocation the head of the humerus when approached posteriorly should lie within 1cm anterior or posteriorly in the line of the posterior lip of the glenoid.
3. If borderline in terms of anterior or posterior (rare) dislocation, then compare with the opposite shoulder and also ask patient to move the humerus and assess how the head is articulating with the glenoid during movement.
4. Use a sharp tip needle at least 5-6cm long in average patient as insertion depth for both aspiration and for injection will normally be 3-4cm. X marks the spot is easier technique to perform for the shoulder than a guided technique.
5. Inject 20mls of 1% lignocaine = 200mg (or 3 mg/kg in average sized patient) for a shoulder dislocation. Aspirate as you introduce needle to the identified depth and about 80% of the time you will aspirate blood in correct spot due to haemarthrosis but this does not always occur so inject anyway if no blood.