Case #66 "She FOOSHed!"
by Charlene Babcock Irvin, MD, FACEP
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A 31 y/o lab tech from another hospital was
walking to her car when she slipped on some
ice. She fell forward and used her right arm
to break the fall (Fall On Out Stretched
Hand = FOOSH). She immediately had severe
pain in her shoulder. She cannot move her
arm because of pain, but denies any numbness
or true weakness. No other injuries. She did
not hit her head (no LOC), or abdomen. She
denies any neck pain and has full range of
motion (ROM) in her neck without pain. She
last ate two hours ago (bagel and coffee for
breakfast).
ROS: Negative except for the acute injury to
her shoulder. No other injuries. No neck
pain.
PMH: G2P2, NSVD (normal spontaneous vaginal
delivery). Previous shoulder dislocation
eight years ago. No surgeries, no medical
problems.
SH: She does smoke, but no drug or alcohol
abuse
Meds: None
FH: Negative
Allergies: None
PE: Blood pressure 150/82, P=110, RR=24,
Temp=afeb, Sat=99%
She is sitting on the cot, grimacing, with
her right forearm resting on her thigh, and
using her left hand to keep it from moving.
She is fully clothed in her winter coat and
clothing, and refuses to remove any clothing
because of severe pain.
HEENT: Normal. No tenderness to c-spine,
normal ROM. No evidence for any head trauma.
HEART: RRR, no murmurs
LUNGS: Normal
ABD: Normal
EXT: She has pulses throughout. She can
grasp with her right hand, but any minute
movement of the arm causes severe shoulder
pain.
She has no parathesias to the deltoid
muscle area, and you note that her right
shoulder has lost its round contour and
appears squarer.
1. What does she have? What is the most
common complication of this injury?
2. Should you give her IM or IV pain
medication?
3. What are the different techniques to fix
this problem?
4. What is her ASA classification?
5. Besides the acute injury, any other issue
you should consider addressing?
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