{"id":2407,"date":"2025-03-10T18:00:00","date_gmt":"2025-03-10T18:00:00","guid":{"rendered":"https:\/\/emultrasound.sdsc.edu\/?p=2407"},"modified":"2025-02-26T18:02:31","modified_gmt":"2025-02-26T18:02:31","slug":"case-43-interscalene-nerve-block-for-shoulder-dislocation","status":"publish","type":"post","link":"https:\/\/emultrasound.ucsd.edu\/index.php\/2025\/03\/10\/case-43-interscalene-nerve-block-for-shoulder-dislocation\/","title":{"rendered":"Case 44: Interscalene Nerve Block for Shoulder Dislocation"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">Josh Gieschen<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Case:<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">32yo male with no PMH who presents following a fall down the stairs with no head strike or loss of consciousness. He endorses left shoulder pain and inability to range his left shoulder. He has never dislocated his shoulder before. His pain is 8\/10 and limited to the L shoulder, worse with motion or palpation.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Vitals:&nbsp; <\/strong>Temp 97.6 \u00b0F | HR 87 | RR 18 | BP 119\/76 | SPo2 100% on RA<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Physical Exam:<\/strong> L arm held internally rotated, flexed, and guarded closely to torso. An obvious step-off deformity was seen directly lateral to glenoid with increased prominence of the shoulder anteriorly. Range of motion was limited severely by pain. The surrounding musculature was tense and tender to palpation. Distal sensation and pulses were intact in the bilateral upper extremities. The remainder of the physical exam was unremarkable.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The patient required hydromorphone 1mg IM during his initial evaluation for pain control.\u00a0 He was noted to have large muscle bulk, with anticipated difficulty with reduction.\u00a0 He was given 1mg lorazepam IM for anxiolysis and consented for an interscalene nerve block.\u00a0 The nerve block was done under ultrasound guidance.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" width=\"525\" height=\"277\" src=\"https:\/\/i0.wp.com\/emultrasound.sdsc.edu\/wp-content\/uploads\/2025\/02\/image-3.png?resize=525%2C277&#038;ssl=1\" alt=\"\" class=\"wp-image-2408\" srcset=\"https:\/\/i0.wp.com\/emultrasound.ucsd.edu\/wp-content\/uploads\/2025\/02\/image-3.png?w=902&amp;ssl=1 902w, https:\/\/i0.wp.com\/emultrasound.ucsd.edu\/wp-content\/uploads\/2025\/02\/image-3.png?resize=300%2C158&amp;ssl=1 300w, https:\/\/i0.wp.com\/emultrasound.ucsd.edu\/wp-content\/uploads\/2025\/02\/image-3.png?resize=768%2C405&amp;ssl=1 768w\" sizes=\"auto, (max-width: 706px) 89vw, (max-width: 767px) 82vw, 740px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Figure 1: Needle-in-plane posterior approach through the middle scalene to the interscalene nerve bundle.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" width=\"525\" height=\"277\" src=\"https:\/\/i0.wp.com\/emultrasound.sdsc.edu\/wp-content\/uploads\/2025\/02\/image-4.png?resize=525%2C277&#038;ssl=1\" alt=\"\" class=\"wp-image-2409\" srcset=\"https:\/\/i0.wp.com\/emultrasound.ucsd.edu\/wp-content\/uploads\/2025\/02\/image-4.png?w=888&amp;ssl=1 888w, https:\/\/i0.wp.com\/emultrasound.ucsd.edu\/wp-content\/uploads\/2025\/02\/image-4.png?resize=300%2C158&amp;ssl=1 300w, https:\/\/i0.wp.com\/emultrasound.ucsd.edu\/wp-content\/uploads\/2025\/02\/image-4.png?resize=768%2C405&amp;ssl=1 768w\" sizes=\"auto, (max-width: 706px) 89vw, (max-width: 767px) 82vw, 740px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Figure 2: Lidocaine surrounds the interscalene nerve bundle.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The patient\u2019s shoulder was subsequently reduced using Kocher\u2019s method.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Discussion:<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In this case, the patient\u2019s shoulder dislocation was clinically evident. POCUS was primarily employed for interscalene nerve block. Given the patient\u2019s high muscle mass, it was anticipated that reduction without targeted analgesia and anxiolysis would be challenging and highly uncomfortable. US guidance allowed isolation of a nerve bundle that would have otherwise been difficult if not impossible to target on its own, and the resulting relaxation and pain improvement allowed reduction to proceed with ease.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Interscalene blocks are commonly used for procedures and pathology of the shoulder and upper arm. They are not recommended for indications involving the hand as the inferior trunk of the brachial plexus is often spared, leading to sparing of the ulnar nerve (1). &nbsp;Possible complications include phrenic nerve paralysis or Horner\u2019s syndrome, though these are relatively rare. Because of these possible complications, interscalene blocks are relatively contraindicated in patients with respiratory insufficiency (2). Overall, interscalene blocks are a highly useful tool for analgesia and relaxation of the shoulder and upper arm and can facilitate procedures in the ED<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>References:<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">1. Operater. \u201cUltrasound-Guided Interscalene Brachial Plexus Nerve Block.\u201d <em>NYSORA<\/em>, 1 Nov. 2024, www.nysora.com\/techniques\/upper-extremity\/intescalene\/ultrasound-guided-interscalene-brachial-plexus-block\/.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">2. Zisquit J, Nedeff N. Interscalene Block. [Updated 2022 Sep 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.&nbsp;Available from: <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK519491\/\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK519491\/<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"Josh Gieschen Case: 32yo male with no PMH who presents following a fall down the stairs with no head strike or loss of consciousness. He endorses left shoulder pain and inability to range his left shoulder. He has never dislocated his shoulder before. His pain is 8\/10 and limited to the L shoulder, worse with &hellip; <p class=\"link-more\"><a href=\"https:\/\/emultrasound.ucsd.edu\/index.php\/2025\/03\/10\/case-43-interscalene-nerve-block-for-shoulder-dislocation\/\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> \"Case 44: Interscalene Nerve Block for Shoulder Dislocation\"<\/span><\/a><\/p>","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_eb_attr":"","_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[4],"tags":[94,85],"class_list":["post-2407","post","type-post","status-publish","format-standard","hentry","category-clinical-cases","tag-nerve-block","tag-shoulder"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.1 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Case 44: Interscalene Nerve Block for Shoulder Dislocation - UCSD Ultrasound<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/emultrasound.ucsd.edu\/index.php\/2025\/03\/10\/case-43-interscalene-nerve-block-for-shoulder-dislocation\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Case 44: Interscalene Nerve Block for Shoulder Dislocation - UCSD Ultrasound\" \/>\n<meta property=\"og:description\" content=\"Josh Gieschen Case: 32yo male with no PMH who presents following a fall down the stairs with no head strike or loss of consciousness. 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