Suspected Shoulder Dislocation
Post-trauma with shoulder pain and deformity
All Pathways
Orthopedic SurgeryEmergency
Anterior Shoulder Dislocation Management
Anterior Shoulder Dislocation Management: Suspected Shoulder Dislocation → Clinical Assessment → Pre-Reduction X-ray → Significant Fracture Present? → ⚠...
Pathway Overview
17 steps
Algorithm Steps
17 total
01Start 02Action Clinical Assessment
History and examination
- Mechanism: fall, sports, seizure, direct trauma
- First-time vs recurrent
- Loss of normal shoulder contour
- Arm held in abduction and external rotation
- Neurovascular exam: Axillary nerve (deltoid sensation)
- Check distal pulses
03Action Pre-Reduction X-ray
Confirm dislocation, rule out fracture
- AP, scapular Y, and axillary views
- Confirm anterior dislocation (humeral head anterior/inferior)
- Look for associated fractures
- Greater tuberosity fracture common
- Assess for Hill-Sachs defect
04Decision Significant Fracture Present?
Assess for fracture-dislocation
05Warning ⚠️ Fracture-Dislocation
Ortho consult before reduction
- Humeral head/neck fracture
- Glenoid fracture >25%
- May require OR reduction
- Risk of further displacement
06Outcome Surgical Stabilization
Arthroscopic Bankart repair or Latarjet
07Action Sedation/Analgesia
Facilitate reduction
- Procedural sedation (propofol, ketamine)
- Intra-articular lidocaine (alternative)
- Entonox for mild cases
- Muscle relaxation critical for success
- Monitor vitals during sedation
08Action Reduction Techniques
Multiple validated methods
- External rotation method: Gentle ER with elbow at 90°
- Cunningham technique: Massage with patient seated
- FARES: Flexion-Adduction-External Rotation
- Stimson: Prone with weight hanging
- Hippocratic: Traction-countertraction (older)
- Success rates 60-90%
09Decision Reduction Successful?
Palpable clunk, restored contour
10Action Post-Reduction Care
Confirm and immobilize
- Repeat neurovascular exam
- Post-reduction X-ray to confirm
- Sling immobilization
- Ice and analgesia
11Action Immobilization
Sling for comfort
- Standard sling 1-3 weeks
- External rotation position debated
- Duration varies (no clear evidence)
- Early gentle pendulum exercises
- Avoid abduction/external rotation
12Decision Recurrence Risk Assessment
Age is key factor
- Age <20: 72-100% recurrence
- Age 20-30: 70-82% recurrence
- Age >50: 14-22% recurrence
- Contact sports, hyperlaxity increase risk
13Action Young Patient (<25)
High recurrence risk
- BESS: Consider primary arthroscopic repair
- MRI to assess Bankart/Hill-Sachs
- Early surgical referral for athletes
- Reduces recurrence from ~70% to ~15%
14Action MRI Assessment
For surgical planning
- Bankart lesion (anterior labral tear)
- Hill-Sachs lesion (humeral head defect)
- On-track vs Off-track Hill-Sachs
- Rotator cuff injury (age >40)
- Glenoid bone loss percentage
- Path rejoins step 06Shared downstream outcome
15Action Conservative Management
Age >30 or low-demand patient
- Physiotherapy program
- Rotator cuff strengthening
- Proprioception training
- Activity modification
- Surgery if recurrent instability
16Outcome Stable Shoulder
Return to activity
17Action Failed Reduction
Consider alternative approach
- Try alternative technique
- Ensure adequate sedation/relaxation
- Consider GA in operating room
- Ortho consult for open reduction if needed
- Path rejoins step 08Shared downstream outcome
Guideline Source
BESS Guidelines + S2 Guideline: First-time Shoulder Dislocation
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Reduction technique success varies by patient and experience
- Posterior/inferior dislocations have different management
- Pediatric considerations differ
- Decision for surgery individualized
Applicable Regions
USEU
Version 1Next review: 2027-01-11
Next steps
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Related Resources
Frequently Asked Questions
What is the Anterior Shoulder Dislocation Management?
The Anterior Shoulder Dislocation Management is a emergency clinical algorithm for Orthopedic Surgery. It provides a structured decision tree to guide clinical decision-making, based on BESS Guidelines + S2 Guideline: First-time Shoulder Dislocation.
What guideline is the Anterior Shoulder Dislocation Management based on?
This algorithm is based on BESS Guidelines + S2 Guideline: First-time Shoulder Dislocation (DOI: 10.1186/s40798-019-0203-2).
What are the limitations of the Anterior Shoulder Dislocation Management?
Known limitations include: Reduction technique success varies by patient and experience; Posterior/inferior dislocations have different management; Pediatric considerations differ; Decision for surgery individualized. Individual patient factors may require deviation from these recommendations.
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