Synopsis
Recognise anterior and posterior shoulder dislocation, document axillary and wider neurovascular function, achieve safe timely reduction, confirm congruence and associated fracture, and prevent recurrent instability and stiffness.
- Anterior dislocation usually produces loss of rounded contour and an abducted slightly externally rotated arm; posterior injury holds internal rotation.
- Before reduction, document radial pulse, refill, deltoid contraction, lateral upper-arm sensation and radial, median and ulnar motor and sensory findings.
- Obtain AP plus axillary or scapular-Y radiographs to confirm direction and identify greater-tuberosity or neck fracture.
Key red flags
Absent pulse, cool hand, expanding axillary swelling or progressive neurological deficit requires immediate reduction and vascular or nerve specialist escalation.
Flattened shoulder contour, prominent acromion and an abducted externally rotated supported arm are typical.
Investigation priorities
Confirm direction, exclude fracture and document the joint before reduction.
Management branches
Clinical deformity suggests a shoulder dislocation.
- Give analgesia, inspect skin and document pulses, refill and named nerve functions.
- Obtain orthogonal imaging unless vascular or skin threat makes delay unacceptable.
Key medicines
Paracetamol for adult shoulder painUse 500 mg to 1 g by mouth as needed for adult arm pain, allowing 4 hours between administrations and limiting the total to 4 g daily.
Procedural sedation medicinesUse only a locally approved weight-based regimen administered by a credentialed clinician with continuous monitoring, airway equipment and formal recovery.