Musculoskeletal Injuries 319297.A 32-year-old male construction worker reports standing on scaf-
folding before it suddenly gave way beneath him. In an attempt to catch his
fall, he spontaneously grabbed and hung on to an overhead beam for
approximately 30 seconds. Two hours later in the ED, the patient presents
with right shoulder pain and decreased range of motion. He denies any loss
of consciousness or other sustained trauma. Vital signs are within normal
limits, except for the patient’s pain scale of 10/10. He is holding his right
arm with the contralateral hand. On physical examination, the patient’s
shoulder appears swollen with no skin breakage. The upper extremity is
without obvious deformity. The patient has palpable brachial, radial, and
ulnar pulses with capillary refill that is less than 2 seconds. He can wiggle
his fingers, but cannot internally rotate his shoulder or raise his right arm
above his head. Pinprick testing reveals paresthesias along the lateral del-
toid of the affected arm. What is the most likely etiology of this patient’s
pain and paresthesias?
a. Acromioclavicular joint sprain
b. Posterior shoulder dislocation with axillary nerve impingement
c. Anterior shoulder dislocation with axillary nerve impingement
d. Anterior shoulder dislocation with median nerve impingement
e. Posterior shoulder dislocation with ulnar nerve impingement