{
  "schema_version": 1,
  "kind": "condition",
  "id": "shoulder-dislocation",
  "name": "Shoulder dislocation",
  "category": "chronic",
  "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)",
  "review_status": "reviewed",
  "verified_against": "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_date": "2026-08",
  "treatments": [
    {
      "id": 1635,
      "generic": "No drug therapy in primary care (Referral & Advice)",
      "line": 1,
      "is_adjunct": false,
      "form": null,
      "strength_mg": null,
      "adult_dose": "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.",
      "adult_duration": "Refer, with advice",
      "dose_source": "No dose - referral pathway, no medicine given in primary care",
      "rationale": "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."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "Children follow the same pathway: recognise and refer. No primary-care medicine is implied.",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": null,
      "brands": [],
      "condition_id": "shoulder-dislocation"
    }
  ]
}