What is one of the findings used in the Quebec decision rule for pre-reduction shoulder X-ray?

• A. Age less than 30
• B. Humerus ecchymosis
• C. Prior dislocation history
• D. Non-traumatic injury

Answer: (B)

The correct answer identifies humeral ecchymosis as one of the findings considered in the Quebec decision rule for pre-reduction shoulder X-rays. This rule was developed to help clinicians determine the need for imaging before attempting reduction in cases of suspected shoulder dislocations.

Humeral ecchymosis, which indicates bruising or bleeding in the area around the shoulder or arm, is a significant finding because it can suggest an associated fracture or soft tissue injury, which may complicate the reduction procedure. The presence of such bruising raises the concern for possible underlying fractures that would not be visible without an X-ray, thus guiding the decision to obtain imaging before proceeding.

This occurs in the context of trauma, where specific physical examination findings help to categorize the risk profile of the injury. Clinicians rely on these indicators to optimize treatment and minimize potential complications during the management of shoulder dislocations. The Quebec decision rule emphasizes the importance of thorough clinical evaluation and appropriate imaging, thus ensuring better patient outcomes.