Novel point-of-care ultrasound approaches for shoulder dislocation: Alternative windows, diagnostic signs, and a stepwise protocol.

INTRODUCTION

Point-of-care ultrasound (POCUS) is increasingly used for shoulder dislocation and provides rapid, radiation-free imaging. The posterior glenohumeral disruption view is the most commonly used and best-validated approach, but it can be limited in patients with pain, restricted mobility, large body habitus, or positioning constraints such as supine procedural sedation or spinal precautions. When the posterior window is not accessible, alternative scanning approaches can assist in diagnosis.

OBJECTIVE

This technical review presents a structured framework of ultrasound windows for shoulder dislocation organized by anatomic position: posterior, anterior, lateral, axillary, and dynamic. The review distinguishes between previously described approaches supported by existing literature and author-proposed signs developed through clinical experience that have not yet been validated. Previously described signs included the Posterior Disruption Sign and the Empty Fossa Sign. Author-proposed signs include the Posterior Gutter, Coracoid Contact, Biceps Groove, Shaft Stop, Dropped Head, and Vessel-Head Inversion signs. For each view, transducer placement, key landmarks, and diagnostic findings are reported. A position-based integration algorithm is presented that recommends view selection according to the patient's arm position (adducted vs. abducted) and clinical context. Dynamic scanning techniques, including the No Slide, Hinge, and Jump signs, are described to support real-time procedural decision-making and confirmation of reduction.

CONCLUSION

When the posterior view is not obtainable, alternative ultrasound windows organized by anatomic approach can assist with diagnosis, allow real-time evaluation, and may reduce reliance on radiography in select patients. This review provides a practical scanning framework and lays the groundwork for future studies evaluating the diagnostic performance of the proposed signs.