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of intra-articular lidocaine may be worthwhile in skeletally mature adolescents given the added benefits of decreased procedure time and potentially reduced cost Clinical Considerations Clinical Recognition The patient with a shoulder dislocation usually presents with substantial pain, holding their injured arm supported by the uninjured arm There is often an obvious abnormality with loss of the usual rounded contour of the shoulder with the dislocation FIGURE 111.11 Hill–Sachs deformity with anterior humeral dislocation A: AP shoulder demonstrating an anteroinferior dislocation of the humerus with impaction between the inferior glenoid rim and the opposing humeral head (arrow ) The impaction produces the articular defect that has been referred to as the hatchet deformity (Hill–Sachs defect) B: Postreduction, AP shoulder After repositioning the humeral head within the glenoid fossa, the residual effect of compression of the articular surface is clearly identified (arrow ) (Reprinted with permission from Yochum TR, Rowe LJ, eds Yochum and Rowe’s Essentials of Skeletal Radiology 3rd ed Philadelphia, PA: Lippincott Williams & Wilkins; 2004.) Triage Considerations The patient should be given adequate pain medication, and the injured upper extremity should be placed in a sling This injury warrants an expedited triage for timely shoulder reduction