Clip 1: In line visualization of needle entering the intra-articular space of anteriorly dislocated shoulder in a lateral to medial orientation.
Clip 2: Hyperechoic anaesthetic visualized being deposited in joint space of anteriorly dislocated shoulder.
A young male who suffers from recurrent shoulder dislocations presents after feeling his right shoulder “pop out” while sleeping. His neurovascular exam is normal, and otherwise well appearing other than restricted range of motion of his right shoulder and pain.
POCUS shows the humeral head anteriorly dislocated in respect to the scapular spine and glenoid fossa. As seen on the clip sequence, an 18 gauge needle is introduced lateral to medial (clip 1) in order to access the glenohumeral joint space where anaesthetic is injected for successful intra-articular infiltration (clip 2). The patient’s shoulder was able to be reduced within minutes.
POCUS Pearl: Simulation and ultrasound guided peripheral IV placement are the training grounds to master the in-line needle/catheter visualization skills wielded in this case.