A 38-YEAR-OLD MAN was brought into our emergency department (ED) after driving his motorcycle at high speed into a tree. The patient, who hadn’t been wearing a helmet, was thrown 30 feet. When EMS arrived, the patient was unresponsive, with his right arm in the air. En route, the patient regained consciousness; he appeared intoxicated and became combative.
The patient was evaluated in the ED and his vital signs were normal. His right arm was abducted and over his head (FIGURE 1). He reported significant pain with palpation and attempts at range of motion. We were unable to place the patient’s arm at his side. Other than some minor abrasions, the patient appeared to have no other injuries.
FIGURE 1Right upper extremity on presentation
Routine laboratory tests showed an alcohol level of 0.175 g/dL and urine toxicology was positive for benzodiazepines and tetrahydrocannabinol. A focused assessment with sonography in trauma (FAST) exam was negative. We ordered a right shoulder x-ray and a chest x-ray.
WHAT IS YOUR DIAGNOSIS?
HOW WOULD YOU TREAT THIS PATIENT?