title: Diagnostic accuracy of ultrasonographic examination in the management of shoulder dislocation in the emergency department.
abstract: OBJECTIVE
  Emergency physicians frequently encounter shoulder dislocation in their practice. The objective of this study is to assess the diagnostic accuracy of ultrasonography in detecting shoulder dislocation and confirming proper reduction in patients presenting to the emergency department (ED) with possible shoulder dislocation. We hypothesize that ultrasonography could be a reliable alternative for pre- and postradiographic evaluation of shoulder dislocation.
  
  
  METHODS
  This was a prospective observational study. A convenience sample of patients suspected of having shoulder dislocation was enrolled in the study. Ultrasonography was performed before and after reduction procedure with a 7.5- to 10-MHz linear transducer. Shoulder dislocation was confirmed by taking radiographs in 3 routine views as a criterion standard. The operating characteristics of ultrasonography to detect dislocation in patients with possible shoulder dislocation and to confirm reduction in patients with definitive dislocation were calculated as the primary endpoints.
  
  
  RESULTS
  Seventy-three patients were enrolled. The ultrasonography did not miss any dislocation. The results of ultrasonography and radiography were identical and the sensitivity of ultrasonography in detection of shoulder dislocation was 100% (95% confidence interval 93.4% to 100%). The sensitivity of ultrasonography for assessment of complete reduction of the shoulder joint reached 100% (95% confidence interval 93.2% to 100%) in our study as well.
  
  
  CONCLUSIONS
  We suggest that ultrasonography be performed in all patients who present to the ED with a clinical impression of shoulder dislocation on admission time. The results of this study provide promising preliminary support for the ability of ultrasonography to detect shoulder dislocation. However, further investigation is necessary to validate the results and assess the ability of ultrasonography in detecting fractures associated with dislocation.
authors.affiliation: Emergency Department, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Saeed
authors.initials: S
authors.lastname: Abbasi
authors.forename: Hooshyar
authors.initials: H
authors.lastname: Molaie
authors.forename: Peyman
authors.initials: P
authors.lastname: Hafezimoghadam
authors.forename: Mohammad Amin
authors.initials: MA
authors.lastname: Zare
authors.forename: Mohsen
authors.initials: M
authors.lastname: Abbasi
authors.forename: Mahdi
authors.initials: M
authors.lastname: Rezai
authors.forename: Davood
authors.initials: D
authors.lastname: Farsi
mesh_terms: D000293:Adolescent; D000328:Adult; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008349:Manipulation, Orthopedic; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D012680:Sensitivity and Specificity; D012783:Shoulder Dislocation / Q000000981:diagnostic imaging* / Q000628:therapy; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult