# Shoulder dislocation - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## 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) ## Treatment metadata - No drug therapy in primary care (Referral & Advice) ## Complete treatment card ```text SHOULDER DISLOCATION 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 against 2 sources listed above (2026-08) 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 Source StatPearls "Anterior Glenohumeral Joint Dislocation" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE) [1st line] Adult 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 Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. 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. Caution 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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