Pseudo-dislocation of the shoulder in a child.

A 6-year-old girl fell off a climbing frame and injured her left shoulder. She was seen the same day in the accident and emergency (A&E) department with diffuse left shoulder pain. On examination diffuse swelling of the shoulder was noted but no deformity was discernible. All movements of the shoulder were grossly restricted and painful. An initial X-ray (Fig. 1) showed a Salter-Harris Type II injury of the left proximal humeral epiphysis. The head of the humerus was noted to be markedly displaced inferiorly. An axillary view to ascertain the relation of the humeral head to the glenoid could not be obtained because of patient discomfort. As a result of the severely subluxed appearance of the shoulder the patient was admitted for observation and further evaluation. An ultra sound scan of the shoulder was obtained which did not show fluid in the joint. The position of the humeral head remained unchanged over the next 3 days despite rest in a triangular sling. A week after the injury a further X-ray (Fig. 2) showed that the subluxation of the head was resolving. The shoulder became more comfortable and a reasonable range of movement returned. The proximal humeral fracture, however, became progressively more displaced but went on to unite soundly. Normal shoulder function was regained by the eighth week after injury. At this stage X-rays showed relocation of the humeral