A 34-year-old woman presents to urgent care with severe pain in her right shoulder after a fall during a tennis match. She landed directly on her shoulder. She is unable to lift her arm but there is no visible deformity. On examination, there are no signs of neurovascular comprise. What is the best next step in managing this patient’s shoulder injury?
- Order a shoulder x-ray to assess for fractures and dislocations
- Apply ice and advise her to rest and follow-up with a PCP if not improved in 3 days
- Perform a shoulder reduction maneuver immediately
- Call EMS for transport to the ED
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Answer: A. If there is no neurovascular compromise, there is no indication for emergent transfer to the ED. Further assessment with x-ray imaging is the best next step; referral to the ED or orthopedic follow-up will likely follow based on the imaging results.
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Tracey Davidoff, MD, FACP, FCUCM, has practiced Urgent Care Medicine for more than 15 years. She is Board Certified in Internal Medicine. Dr. Davidoff is a member of the Board of Directors of the Urgent Care Association and serves as Co-Editor-in-Chief of the College of Urgent Care Medicine’s “Urgent Caring” publication. She is also the Vice President of the Southeast Regional Urgent Care Association and a member of the editorial board of the Journal of Urgent Care Medicine. At EB Medicine, Dr Davidoff is Editor-In-Chief of Evidence-Based Urgent Care, and co-host of the Urgentology podcast.
