Medical Imaging Analysis Report

1. Radiological Findings

The patient is a 101-year-old female with a history of osteoporosis. She presented with abnormal lifting of the right shoulder and a sustained abducted posture following a fall. The provided shoulder X-ray shows:

• The humeral head (A) is located below the glenoid of the shoulder joint and does not articulate normally with the glenoid fossa.
• The humeral shaft (C) runs parallel to the scapular spine (D), suggesting a typical “erect” or “upraised” posture (Luxatio Erecta).
• The humeral head can be palpated (or observed radiographically) in the axillary region, obviously below the glenoid fossa.
• No obvious large fracture fragments are visible; however, given the patient’s advanced age and osteoporosis, the possibility of small fracture lines or avulsion of tubercles should not be overlooked.

2. Potential Diagnoses

Combining the patient’s history and radiographic findings, the following potential diagnoses should be considered:

1. Inferior Shoulder Dislocation (Luxatio Erecta Humeri):
   This is characterized by the patient’s upper limb being passively or fixated in abduction with the forearm raised, and the humeral head located in the axilla or significantly lower than the glenoid. It typically results from a fall or high-impact force that drives the humeral head downward, which aligns with the radiographic features in this case.
2. Fracture-Dislocation of the Shoulder:
   In elderly patients, a fall can cause proximal humerus fractures or avulsions near the glenoid. However, this case only demonstrates signs of dislocation without clear large fracture fragments. An occult fracture or avulsion injury must still be considered.
3. Other Uncommon Shoulder Injuries (e.g., Glenoid Labrum Tear, Tendon Injuries, etc.):
   These may occur with dislocation. If necessary, MRI or other imaging can be used later to further assess the integrity of the tendons and ligaments.

3. Final Diagnosis

Based on the mechanism of falling, the patient’s advanced age and osteoporosis, and the typical radiological presentation of an inferior shoulder dislocation, the most likely diagnosis is:

“Inferior Shoulder Dislocation (Luxatio Erecta Humeri)”.

If a fracture or soft tissue injury is clinically or radiologically suspected, further imaging (CT, MRI) or an orthopedic consultation may be required to clarify additional structural damage.

4. Treatment Plan and Rehabilitation

(1) Treatment Strategy

• Closed Reduction: Under adequate analgesia or general anesthesia, perform traction-countertraction reduction in the emergency department. An immediate post-reduction X-ray is necessary to confirm the reduction and rule out iatrogenic fractures.
• Post-Reduction Management: If the reduction is successful and no significant fracture is present, a shoulder immobilizer (either in abduction or adduction, depending on physician recommendation) may be applied for 2–3 weeks. Close follow-up for fracture risk and neurovascular status is advised.
• Surgical Indications: In cases of significant fractures, displaced fracture fragments, unsuccessful closed reduction, or severe concomitant soft tissue injuries, orthopedic surgical intervention (internal fixation, repair of ligaments or rotator cuff, etc.) should be considered.

(2) Rehabilitation / Exercise Prescription

The rehabilitation program should follow the principles of gradual progression, individualized care, and safety. The recommendations are as follows:

1. Early Stage (Immobilization Phase, ~2–3 weeks):
   Focus on rest and stabilization:
   • Use a shoulder brace or immobilizer to minimize movement of the injured shoulder and prevent secondary injury.
   • Perform light exercises for the unaffected limbs and lower extremities, such as handgrip exercises or ankle pumps, to prevent thrombosis and maintain muscle activity.
2. Mid Stage (After Removing Immobilization, 2–6 weeks):
   Emphasize the restoration of joint range of motion and mild muscle strengthening:
   • Within pain tolerance, conduct active or assisted passive range-of-motion exercises for the shoulder joint. Start with small ranges and avoid forceful or excessive abduction in one step.
   • Gradually incorporate isometric or isotonic exercises with resistance bands or light weights to strengthen the rotator cuff and surrounding muscles, thus stabilizing the joint.
3. Late Stage (Recovery Phase, after 6 weeks):
   The goal is to restore function and continue muscle strengthening:
   • Once adequate range of motion is achieved, progressively increase the intensity and repetitions of resistance training using light dumbbells or resistance bands.
   • Based on the patient’s overall health and degree of osteoporosis, low-impact aerobic activities may be included (e.g., slow walking, stationary cycling).
   • If the patient’s progress is stable and approved by the orthopedic specialist, proprioceptive and functional training can be introduced, such as compound shoulder movements to simulate daily activities (dressing, reaching overhead, etc.).
4. FITT-VP Principle:
   Considering the patient’s advanced age and osteoporosis, the following is recommended:
   • Frequency (F): 3–5 times per week, adjusting as tolerated.
   • Intensity (I): Maintain low intensity initially (one level below the patient’s perceived exertion); progress slowly thereafter.
   • Time (T): 10–15 minutes per session at first, gradually extending to 20–30 minutes. Consider dividing sessions to avoid overfatigue.
   • Type (T): Emphasize range-of-motion exercises, rotator cuff function training, and low-impact aerobic activities.
   • Volume (V): Gradually accumulate sets and time per session based on objective and subjective recovery indicators.
   • Progression (P): Increase intensity or duration only if there is no notable worsening of pain or adverse reactions.

Throughout rehabilitation, monitor blood pressure, cardiopulmonary function, shoulder pain, swelling, and muscle strength. Revisit or adjust the plan as necessary.

Disclaimer: This report is a reference-based analysis based on the currently provided information and cannot replace in-person consultation or professional medical advice. Specific diagnostic and treatment decisions must be made in conjunction with clinical examinations, laboratory tests, and other auxiliary examinations, and should follow a specialist physician’s guidance.