Dawaa Reference

chronic

Shoulder dislocation

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 sources

ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class LD48.03 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Shoulder Dislocations Overview - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK459125/ · Anterior Glenohumeral Joint Dislocation - StatPearls - NCBI Bookshelf - disease-level clinical article (shoulder-dislocation-full.txt)

Verified against2 documents
  • No dose - referral pathway, no medicine given in primary care
  • Anterior Glenohumeral Joint Dislocation - StatPearls - NCBI Bookshelf - disease-level clinical article (shoulder-dislocation-full.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (1)

  • A fit or an electric shock is the history that lies behind a backward dislocation [seizures · shock]

Signs — what you find (10)

  • The head of the humerus can be seen and felt sitting abnormally far forward
  • Inspect and palpate all three joints of the shoulder complex in turn, the sternoclavicular, the acromioclavicular and the glenohumeral
  • Record the neurovascular state before attempting any reduction
  • The axillary nerve runs along the humeral neck and quadrilateral space, which is why it is the one most often hurt
  • That nerve is intact if sensation over the upper arm is preserved
  • Deltoid should fire on abduction if the nerve is working
  • Check the axillary artery by distal perfusion and pulses, with no swelling or growing haematoma in the armpit
  • In the backward type the limb is held turned inwards and will not rotate out, unlike the forward one
  • The rare downward dislocation presents with the arm stuck up in full abduction
  • More bruising than expected points to injury of soft tissue or bone [bruising]

Tests (10)

  • Every traumatic shoulder needs plain films in more than one view at the outset
  • The AP film shows displacement up and down; a view at right angles to it is needed for front-to-back displacement
  • The axillary view needs the arm abducted and is often impossible because of pain or the dislocation itself
  • The Velpeau view avoids abduction: the arm stays in a sling and the patient leans back 30 to 40 degrees over the cassette
  • A scapular Y projection settles where the humeral head lies in relation to the glenoid when other films are hard to read
  • Later films add a Stryker notch view for a Hill Sachs lesion on the humeral head and a Westpoint view for bone loss at the glenoid
  • Younger patients get an MR arthrogram for the labrum; older ones an MRI to look for a torn rotator cuff alongside
  • CT measures how much bone has gone from the humeral head or glenoid in long-standing dislocation and shapes the treatment
  • A Zanca view added to the clavicle film uses a beam tilted 30 degrees upwards
  • Which way the joint has gone must be settled on films taken before reduction

If not this — what else fits (7)

  • Backward dislocation, which is easily overlooked in the emergency department
  • Luxatio erecta, the downward variety and the least common of them
  • An isolated lesser tuberosity fracture, which should prompt a hunt for a backward dislocation
  • Acromioclavicular joint separation, some 9% of shoulder girdle injuries
  • Disruption of the sternoclavicular or acromioclavicular joint at the same time
  • Fracture of the proximal humerus, either instead of or alongside the dislocation
  • Fracture dislocation with a fully displaced head, where closed reduction usually fails and urgent surgery may be needed

SourceStatPearls "Anterior Glenohumeral Joint Dislocation" - disease-level clinical article

Presentation findings are traced to the source above.

1

NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)

1st line
Adult dose and duration

Glenohumeral dislocation is common trauma, typically anterior, from a fall or sports injury; needs reduction (often in an emergency setting), post-reduction imaging, and follow-up for recurrent instability. - Refer, with advice

Paediatric dose

Children follow the same pathway: recognise and refer. No primary-care medicine is implied.

Dose source

No dose - referral pathway, no medicine given in primary care

Why

Glenohumeral dislocation is common trauma, typically anterior, from a fall or sports injury; needs reduction (often in an emergency setting), post-reduction imaging, and follow-up for recurrent instability.

Cautions
  • Axillary nerve injury (loss of deltoid sensation), vascular compromise of the arm, recurrent or irreducible dislocation.
  • No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to.
  • RED FLAG - A thorough neurovascular exam (axillary nerve - sentinel patch sensation and deltoid firing; axillary artery - distal pulses/perfusion) must be performed and documented before any reduction attempt, since axillary nerve injury occurs in about 42% of acute anterior dislocations and arterial injury, though rare, carries high morbidity if missed.
  • RED FLAG - Reduction should not be delayed beyond 24 hours - delay raises the risk of unstable reduction, muscle spasm, and neurovascular compromise.
  • RED FLAG - Suspected proximal humerus fracture-dislocation (e.g. marked ecchymosis, completely displaced humeral head) needs emergent orthopedic surgery consultation, since closed reduction is often unsuccessful and urgent open reduction may be required.
  • A shoulder dislocation that follows a seizure or an electric shock is likely to be posterior, and posterior dislocations are commonly missed at first presentation.
  • An isolated lesser tuberosity fracture on X-ray should prompt a search for an underlying posterior shoulder dislocation.
  • A patient holding the arm fixed in a hyper-abducted, overhead position has an inferior dislocation (luxatio erecta), which carries a high rate of neurovascular injury.
  • The direction of the dislocation must be confirmed radiographically before any reduction attempt.
  • The Hippocratic technique, placing a foot in the axilla as counter-traction, is no longer favoured because it risks causing brachial plexus and vascular injury.
  • After a successful reduction, repeat the neurovascular examination, confirm the position on radiographs, and immobilise the arm in a sling.
  • Acromioclavicular joint separation can be mistaken for a shoulder dislocation.
  • In a patient over 40 with recurrent instability, a rotator cuff tear is the more likely underlying cause.
  • A patient under 25 who plays contact sport should be counselled that the risk of the shoulder dislocating again is very high.

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