Radiology Review

Give Her a Shoulder to Cry on

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Give Her a Shoulder to Cry on

After a motor vehicle collision, a 70-year-old woman is brought to your emergency department by EMS personnel. She was a restrained driver in a vehicle crossing an intersection when she was broadsided by a tractor trailer traveling at high speed. Her airbags deployed, and she believes she briefly lost consciousness. Her biggest complaint is pain in her right shoulder.

Her medical history is significant for hypertension and hypothyroidism. On primary survey, you note an elderly woman who is in full cervical spine immobilization on a long backboard. Her Glasgow Coma Scale score is 15. She is in mild distress but has normal vital signs.

The patient has scattered abrasions and bruises on her body. Her right shoulder has mild to moderate tenderness to palpation and a decreased range of motion. Distally in that arm, she has good pulses and is neurovascularly intact.

You obtain a portable radiograph of the right shoulder (shown). What is your impression?


Give Her a Shoulder to Cry on


The radiograph demonstrates an acute horizontal fracture through the humeral neck. There is some slight lateral displacement of the fracture fragment.

The patient’s right arm was placed in a sling. Prompt orthopedic consultation was then obtained.

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