A 25-year-old basketball player presents to the emergency department after falling on an outstretched arm during a game. Which assessment finding would be most indicative of an anterior shoulder dislocation?

1 The affected arm is held close to the body with the elbow flexed at 90 degrees and the shoulder internally rotated
2 Loss of the normal rounded contour of the shoulder with a visible depression below the acromion ✓ 정답
3 Numbness and tingling in the fingers of the affected extremity
4 Severe pain that increases with any attempt at shoulder movement

해설

Loss of normal shoulder contour with a depression below the acromion is the hallmark of anterior dislocation. Other options like pain or numbness are common but not specific to anterior dislocation.

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심화 해설

Clinical Judgment This question assesses your ability to identify the most specific diagnostic clue through physical examination findings. While all options can be associated with a shoulder dislocation, you must find the pathologic appearance that most directly indicates an Anterior Shoulder Dislocation. Option 2's "Loss of the normal rounded shoulder contour and a visible depression below the acromion" is a unique finding caused by the humeral head dislocating anteriorly from the glenoid, making it the most decisive for diagnosis. The other options are non-specific or suggest complications, such as pain, protective posturing, or neurological symptoms. Memory Tip: The mnemonic to remember the appearance of an anterior dislocation is "Square Shoulder." The normal rounded shape is lost, and the acromion becomes prominent, giving the shoulder an angular (Squared-off) appearance. KR vs US: The characteristic appearance of an anterior dislocation is considered equally important in both Korea and the US. However, in the NGN exam, the key is to select the specific, visual physical finding that reflects the pathophysiology rather than simply 'severe pain'.

임상 시나리오

Clinical Practice Guide
When assessing a patient with anterior shoulder dislocation:
1. Neurovascular status assessment is essential!: Be sure to check and document sensation (especially in the axillary nerve distribution area of the brachial nerve), motor function, and peripheral pulses (radial artery, axillary artery).
2. Pre- and post-reduction X-rays are standard diagnostic procedures.
3. After reduction, apply a Shoulder Immobilizer or bandage for stabilization.

Caution: In SATA (Select All That Apply) questions asking about "signs of anterior shoulder dislocation," option 2 is almost always included in the correct answer. Option 1 (protective posture) and option 4 (pain) are also commonly included, but option 3 (numbness/paresthesia) is a sign of the complication of nerve injury, so the answer may vary depending on whether the question focuses on 'diagnostic findings' or 'management considerations.'

핵심 개념

Anterior Shoulder Dislocation — Anterior shoulder dislocation. The humeral head has slipped forward out of the glenoid cavity. The most common type of shoulder dislocation.
Acromion — Acromion. It is part of the shoulder blade (scapula) and forms the bony projection at the top of the shoulder. When dislocated, the area below it appears sunken.
Squared-off Shoulder — Square shoulder. A characteristic appearance of anterior shoulder dislocation, where the normal rounded shoulder contour is lost and the acromion protrudes, making the shoulder look angular.
Axillary Nerve — Axillary nerve. It branches from the brachial plexus and supplies motor nerves to the deltoid and teres minor muscles, and sensory nerves to the lateral skin of the shoulder. It is the most commonly injured nerve in shoulder joint dislocations.
Neurovascular Assessment — Neurovascular assessment. This is an essential evaluation that must be performed after musculoskeletal injuries, especially dislocations or fractures, to check sensation, movement, and circulation (pulse, skin color, temperature) in order to detect nerve or blood vessel damage early.

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A 25-year-old basketball player presents to the emergency department after falling on an outstretched arm during a game. Which assessment finding would be most indicative of an anterior shoulder dislocation?

심화 해설

임상 시나리오

핵심 개념

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