Medical Imaging Analysis Report

Imaging Findings

Based on the provided shoulder X-ray films (including the anteroposterior and Y views), the following findings can be observed:

• The humeral head (H) is markedly displaced anteriorly relative to the glenoid (G), located beneath the coracoid process (C).
• The shape of the shoulder joint appears flattened, with the acromion losing its normal rounded contour, consistent with an anterior dislocation of the joint.
• No obvious large fractures are observed, but caution should be taken regarding potential concomitant bony injuries, such as:
  • Avulsion or avulsion-type fracture of the anterior glenoid labrum (Bankart fracture).
  • Posterolateral compression fracture of the humeral head (Hill-Sachs lesion).

Potential Diagnoses

Considering the patient’s history of trauma and the radiographic findings, the potential diagnoses include:

1. Anterior Shoulder Dislocation: The most common type of shoulder dislocation, often due to external forces causing the humeral head to dislocate anteriorly when the shoulder is abducted and externally rotated.
2. Concurrent proximal humeral fracture
3. Concurrent labral tear or Bankart lesion
4. Concurrent Hill-Sachs compression fracture

Clinically, when the shoulder undergoes a sudden strong force leading to anterior dislocation, the aforementioned associated injuries or fractures frequently occur. Therefore, further imaging studies (CT, MRI, or CT arthrography) are necessary for definitive evaluation.

Final Diagnosis

Taking into account the patient’s mechanism of injury (fall), clinical presentation (altered shoulder contour, pain, and limited range of motion), and radiographic findings, the most likely diagnosis is:

Anterior Shoulder Dislocation.

To rule out or confirm concurrent fractures or soft tissue injuries (Bankart lesion, Hill-Sachs lesion, etc.), additional CT or MRI examinations may be considered.

Treatment Plan and Rehabilitation

Treatment Strategy

• Closed Reduction: For anterior shoulder dislocations without a significant fracture, a manual reduction can be performed under sedation or anesthesia, followed by X-ray confirmation to ensure proper joint alignment.
• Surgical Treatment: In cases where there is an obvious fracture (e.g., proximal humeral fracture) or significant soft tissue damage, open reduction and internal fixation (ORIF) may be required, along with repair of the labrum, ligaments, or other structures as needed.
• Protective Immobilization: After reduction, a shoulder brace or sling is typically used for about 2–3 weeks (depending on the healing status) to protect the joint and reduce pain.

Rehabilitation / Exercise Prescription Recommendations

Rehabilitation should follow a gradual, individualized approach. Below is a brief FITT-VP framework:

1. Immobilization and Rest (Weeks 1–2):
   • Frequency: Minimize active movement daily, focusing on immobilization and rest.
   • Intensity: Aim primarily for protection and pain relief, avoiding any forceful shoulder movements.
   • Time: Avoid removing the sling or brace for prolonged periods until tissues stabilize.
   • Type: Passive movement or only mild shoulder activity as needed for daily living.
   • Progression: Gradually increase range of motion based on pain or swelling.
2. Active Movement and Functional Training (Weeks 3–6):
   • Frequency: At least 3–4 sessions of active joint movement training per week.
   • Intensity: Start with small-range, low-resistance activities and gradually increase the range of motion (e.g., flexion, abduction), avoiding significant pain.
   • Time: About 10–15 minutes per session, progressing gradually.
   • Type: Range-of-motion exercises (e.g., pendulum exercises, sliding exercises). A sling or resistance band training may be performed under a therapist’s guidance.
   • Progression: As pain subsides and swelling decreases, progressively increase range of motion and resistance.
3. Muscle Strengthening and Stability Training (From Week 6 to 3 Months):
   • Frequency: 3–5 times per week focusing on strengthening the shoulder muscles.
   • Intensity: Moderate-resistance strength training (e.g., using resistance bands or light weights), with emphasis on the rotator cuff muscles (supraspinatus, infraspinatus, teres minor, subscapularis) and the scapular stabilizers.
   • Time: 15–20 minutes per session, adjusted according to tolerance.
   • Type: Gradually transition to isotonic, isokinetic, and eccentric exercises, consistently monitoring shoulder stability and coordination.
   • Progression: Gradually progress to loads resembling daily activities or sports demands, ensuring movement stability and avoiding reinjury.

Additionally, if the patient has potential bone quality issues or poor cardiopulmonary function, training intensity and frequency should be adjusted accordingly. Consultation with a sports medicine or rehabilitation medicine specialist may be required.

Precautions

• Attend regular follow-up visits to monitor the status of the shoulder reduction and soft tissue healing.
• If severe pain, joint instability, or reduction failure occurs, seek medical attention promptly for further management.
• Gradually resume daily and sports activities in the later rehabilitation stages, but avoid high-intensity or large-range movements prematurely.

Disclaimer: This report is a reference medical analysis based on the available information and does not replace in-person consultation or professional medical advice. For urgent issues or special situations, please seek medical attention promptly.