Shoulder dislocation

Background
  • Humerus separates from the scapula at the glenohumeral joint
  • Partial dislocation of the shoulder is referred to as subluxation

Types

Differential Diagnosis

Shoulder and Upper Arm Diagnoses

Traumatic/Acute:

Nontraumatic/Chronic:

Refered pain & non-orthopedic causes:

Evaluation
  • Plain film X-ray
    • Include anteroposterior, scapular Y, and axillary views
    • Associated fractures include:
      • Hills-Sachs: cortical depression in the humeral head
      • Bankart: glenoid labrum disruption with bony avulsion
      • Humeral greater tuberosity fracture
  • Ultrasound

Management
  • Reduction
    • See individual types for specific techniques
    • Do not attempt to reduce chronic dislocations (>4 weeks) in ED due to risk of arterial injury - these require reduction in the OR
  • Cochrane review notes lower complications, equal pain control, and shorter ED stay with intra-articular lidocaine vs. procedural sedation
    • 20 mL of 1% lidocaine intra-articular injection[1]

Disposition
  • Uncomplicated dislocation can be discharged after reduction
  • Recurrence rate around 27% if older than 30 years and 72% is younger than 23 years[2]

See Also
  • Shoulder diagnoses

Video

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References
  1. Intra-articular lignocaine versus intravenous analgesia with or without sedation for manual reduction of acute anterior shoulder dislocation in adults (Review) Cochrane Database Syst Rev. 2011 Apr 13;(4):CD004919 full text
  2. Watson S, Allen B, Grant JA. A Clinical Review of Return-to-Play Considerations After Anterior Shoulder Dislocation. Sports Health. 2016; 8(4):336-341.
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