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previews",[218,229,234,239,246],{"type":219,"data":220},"video",{"readDurationInSeconds":221,"video":222},363,{"platform":223,"name":224,"url":225,"size":226},"YouTube","Imaging a shoulder dislocation with ultrasound","https:\u002F\u002Fwww.youtube.com\u002Fwatch?v=WQMQUEcBx0g",{"width":227,"height":228},200,113,{"type":230,"data":231},"free_text",{"readDurationInSeconds":232,"text":233},9.333333333333334,"\u003Cp>Dealing with a shoulder dislocation? No problem! By the end of this video, from our Ultrasound-Guided Nerve Block Masterclass, you'll know how to use ultrasound to identify shoulder dislocations, \u003Cem>and\u003C\u002Fem> make them easier to reduce with a simple ultrasound-guided joint injection.\u003C\u002Fp>",{"type":230,"data":235},{"readDurationInSeconds":236,"title":237,"text":238},13.866666666666667,"Join our Ultrasound-Guided Nerve Block Masterclass course today!","\u003Cp>Master the use of ultrasound to guide your nerve block procedures with our \u003Cstrong>\u003Ca href=\"https:\u002F\u002Fwww.medmastery.com\u002Fcourse\u002Fnerve-block-masterclass\">Ultrasound-Guided Nerve Block Masterclass\u003C\u002Fa>\u003C\u002Fstrong> course. You'll learn how to identify and anesthetize nerves in the neck, torso, and lower extremities with the help of ultrasound, and build an appropriate nerve block protocol within your hospital. \u003C\u002Fp>",{"type":240,"data":241},"cta",{"readDurationInSeconds":242,"text":243,"buttonText":244,"buttonUrl":245},3.466666666666667,"Become a great clinician with our video courses and workshops","Start learning for free","https:\u002F\u002Fwww.medmastery.com\u002Fuser\u002Fregister",{"type":230,"data":247},{"readDurationInSeconds":248,"title":249,"text":250},167.46666666666667,"Video Transcript","\u003Cp dir=\"ltr\">\u003Cstrong>[00:00:00] \u003C\u002Fstrong>There are two key reasons to use ultrasound in shoulder dislocations. The first is to find and to diagnose the shoulder dislocation. We've all been in that situation, is it out or is it in? The last thing you want to do is order an x-ray, wait the ten minutes for the x-ray tech to come and then wait another ten minutes until it's loaded up and then try to determine is it out, is it in, is it anterior, \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:00:30] \u003C\u002Fstrong>is it posterior? An ultrasound of the shoulder will tell you this in a moment's time. The second reason to ultrasound a shoulder is to aid in the injection of anesthetic, into the shoulder joint itself, that is to assist you with the reduction procedure. In this module, we will solely focus on learning how to find and locate the dislocation. The shoulder joint itself is fascinating. It's the most mobile joint in the body. \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:01:00] \u003C\u002Fstrong>It moves up, it moves down, it moves left, it moves right. Let's hearken back to our orthopedic training for med school. Most shoulder dislocations are anterior. They move towards the front of the body. This translation forward of the humeral head is the movement of least resistance. When shoulders move posteriorly, the rotator cuff and the deltoid muscles act to inhibit \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:01:30]\u003C\u002Fstrong> this movement. That's why posterior dislocations are so much less common. In terms of probe position to locate the shoulder dislocation, your probe will be located in the posterior aspect of the shoulder joint, along the scapular spine. The best way to do this is to have your patient try to sit upright, I know it's hard sometimes, but talk them through it and shrug their shoulders back. This ergonomic good posture position creates anatomic \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:02:00] \u003C\u002Fstrong>consistency. It's also incidentally the position to have your patient in for their subsequent reduction procedure. In terms of probe selection, the two most commonly used are the linear probe and the curvilinear probe. For larger patients, you'll need the curvilinear probe here on the right. This probe, as you see, is bigger and it goes deeper into the body. The linear probe on the left of your screen doesn't go as far \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:02:30]\u003C\u002Fstrong> into the body, so it won't give you the image you need in the grand majority of patients. So, let's look here at where our probe is on our patient. To orient you, the patient's head here is facing forward. The back is here, to the right of the screen. You can see gel is already applied to our target area. Here, watch as your operator identifies the scapular spine. The probe is going to be placed directly on \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:03:00] \u003C\u002Fstrong>the spine and then moved downward. You'll see here as your operator internally and externally rotates the shoulder. Quickly, let's watch this again as it's really important. Scapular spine, probe on the spine, slide just a bit downward and then if you can, if the patient lets you, subtle little movements, \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:03:30]\u003C\u002Fstrong> not likely this vigorous, but subtle little movements in and out of their arm. The corresponding ultrasound image created can be seen here. Remember that the area that is closest to you on your screen is actually the back of the patient, so you are looking forward. You are looking towards the front of the patient. Here's your scapular spine. Notice the hyperechoic rim of the spine and the shadowing beyond it. \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:04:00] \u003C\u002Fstrong>What do you think this is here, the circular hyperechoic rim? Well, that's the humeral head sitting right where it should be in the glenohumeral joint. And as you see, when I press play, you'll see this humeral head move back and forth in a comfortable fashion. Here's that internal and external rotation. There's the nice crisp rotator cuff muscle on the top of the humeral head and as you saw that humeral \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:04:30] \u003C\u002Fstrong>head moving back and forth comfortably in the socket. So, to remind you, deep is front. The further away the objects appear on your screen, the more on the anterior surface of the patient's body, they lie. So, an anterior dislocation, looking from the back of the patient, should be further away from you than a normal shoulder anatomy. So, let's look at what an anterior dislocation \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:05:00] \u003C\u002Fstrong>looks like. Again, recognize your hyperechoic bone. This is your scapular spine and then notice the humeral head is going to not be where it should be, right next to the scapular spine but rather further away from you, anterior location. There's your humeral head. Here it is in video form. You're not being able to move the patient back \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:05:30] \u003C\u002Fstrong>and forth as much as you were before because they're in pain, but you can see hyperechoic humeral head here and then the spine of the scapular here.\u003C\u002Fp>",{"courses":252,"showAwardsBelow":48},[253,273],{"id":254,"isFreeCmeCourse":255,"title":256,"type":257,"specialization":258,"teachers":260,"cmeCredits":262,"teacherIllustration":263,"backgroundImage":264,"relativeUrl":265,"lastChanged":266,"created":267,"description":268,"relativeURL":265,"meta":269},4955,false,"Ultrasound-Guided Nerve Block Masterclass","course",[259],"Ultrasound",[261],"Peter Croft, MD",5,"https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F99f55f0f-f60e-46de-a271-77e8a2593275","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F99f55f10-e5e4-42af-86af-442bcda18a88","\u002Fcourses\u002Fultrasound-guided-nerve-block-masterclass","1769024283","1527155216","Nerve blocks are becoming more common in all fields of medicine for good reason—they are super efficient! 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This course builds on Medmastery’s POCUS Essentials course, taking your skills to the next level. Master advanced POCUS in a variety of applications—pulmonary, cardiac, airway, gastrointestinal, and musculoskeletal—with tricks and tactics that will help you make a diagnosis, build a care plan, and guide resuscitation.",{"duration":287,"quizzes":288,"lessons":289},17338,8,59,{"id":291,"name":261,"image":292,"profession":293,"relativeUrl":296,"specializations":297},4956,"https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cf01-1862-4650-8239-bf7fbee12ad3",{"name":294,"description":295},"Emergency medicine physician","Peter is an Associate Professor of Emergency Medicine and Ultrasound Co-Director at Maine Medical Center, Portland, USA.","\u002Fteachers\u002Fpeter-croft-md",[259],199,"4m",[301,329,347],{"id":302,"title":303,"text":304,"image":305,"author":313,"path":322,"readDuration":323,"readDurationFormatted":324,"internal":325},1352,"Injectable cholesterol medication: using PCSK9 inhibitors","Not all patients reach their LDL targets with oral therapy. Learn when injectable cholesterol medication helps and how PCSK9 inhibitors work.",{"alt":306,"title":307,"size":308,"location":310},"Two PCSK9 inhibitor autoinjector pens—an injectable cholesterol medication—shown on a light blue background.","",{"width":309,"height":309},900,{"bucket":311,"key":312},"public-drupal-medmastery-assets-production","\u002F2026-05\u002FC121(3)_magazine image.png",{"id":314,"title":315,"relativeURL":316,"image":317,"professionLong":318,"profession":319,"weight":321},1563,"Franz Wiesbauer, MD MPH","\u002Fteachers\u002Ffranz-wiesbauer-md-mph","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cef0-41ee-4005-9e4a-d8711c816401","Franz is the founder and CEO of Medmastery. He is an internist with a specialization in cardiology and a master’s in public health from Johns Hopkins University.",{"name":320},"Internist",4,"\u002Fmagazine\u002Fpcsk9-injectable-cholesterol-medication",279,"5m",{"created":326,"updated":327,"published":328},1779483663,1779495630,1779495631,{"id":330,"title":331,"text":332,"image":333,"author":339,"path":341,"readDuration":342,"readDurationFormatted":299,"internal":343},1351,"Starting statins as first-line therapy for hyperlipidemia","Starting statins: how to choose the right agent for your patient, match statin intensity to cardiovascular risk, and monitor effectively after initiation.",{"alt":334,"title":307,"size":335,"location":337},"Healthcare provider discussing starting statins with a patient and reviewing a medication bottle",{"width":336,"height":336},660,{"bucket":311,"key":338},"\u002F2026-05\u002FC121(2)_magazine image.png",{"id":314,"title":315,"relativeURL":316,"image":317,"professionLong":318,"profession":340,"weight":321},{"name":320},"\u002Fmagazine\u002Fstarting-statins-first-line-therapy",238,{"created":344,"updated":345,"published":346},1778960150,1779196374,1778961827,{"id":348,"title":349,"text":350,"image":351,"author":357,"path":359,"readDuration":360,"readDurationFormatted":361,"internal":362},1350,"How to recognize INOCA (ANOCA) on an exercise stress test ","Angina, abnormal stress test, clean coronaries—that's INOCA (or ANOCA), and it carries real risk. 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