Dawaa Reference

Clinical reference

Dislocation or subluxation

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

Evidence status

Checked against the sources named below

Sources3 sources

Anterior Glenohumeral Joint Dislocation - StatPearls (NCBI Bookshelf NBK557862) - https://www.ncbi.nlm.nih.gov/books/NBK557862/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class LD48 - condition scope only, no dose · MSF Essential Drugs 2024 - paracetamol (oral)

Verified against2 documents
  • Anterior Glenohumeral Joint Dislocation - disease-level clinical article (dislocation-subluxation-clinical.txt)
  • MSF Essential Drugs 2024 - paracetamol (oral)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Signs — what you find (8)

  • The humeral head can be seen and felt sitting in an abnormally anterior position
  • Axillary nerve function is confirmed by sensation over the proximal outer arm and deltoid firing on abduction
  • Axillary artery integrity is confirmed by distal perfusion, intact pulses, and no expanding swelling or hematoma
  • Unlike an anterior dislocation, a posterior dislocation holds the arm internally rotated with reduced external rotation
  • An isolated lesser tuberosity fracture should raise suspicion for an underlying posterior dislocation
  • Inferior dislocation (luxatio erecta) leaves the arm fixed in a hyper-abducted position and carries a high rate of neurovascular injury
  • AC joint separation, which can be mistaken for a shoulder dislocation, accounts for 9% of shoulder girdle injuries
  • A proximal humerus fracture can show increased bruising suggesting soft-tissue or bone injury, sometimes with a fully displaced humeral head [bruising]

Tests (8)

  • Plain films with multiple views are required for the initial workup of any traumatic shoulder injury
  • An AP view shows cranial-caudal displacement, and an orthogonal view is needed to assess anteroposterior displacement
  • The Velpeau view, which needs no abduction and keeps the arm in a sling, is an alternative when the axillary view is too painful
  • The scapular Y view assesses humeral head position relative to the glenoid when other views are hard to interpret
  • Stryker notch views assess a Hill-Sachs lesion and Westpoint views assess bony glenoid loss
  • MR arthrogram evaluates labral pathology in younger patients, and MRI is considered in older patients for a concurrent rotator cuff tear
  • CT is useful in chronic dislocations to quantify humeral head or glenoid bone loss for treatment planning
  • A Zanca view, with the beam angled 30 degrees cranial, is added to standard clavicle films to assess the AC joint

If not this — what else fits (4)

  • Posterior dislocation, often from a seizure or electric shock, is frequently missed on initial presentation
  • Inferior dislocation (luxatio erecta) is the rarest type and results from high-energy trauma
  • AC joint separation can be mistaken for a glenohumeral dislocation and is graded by the six-type Rockwood system
  • A proximal humerus fracture can present similarly to or alongside a dislocation, sometimes needing urgent surgical referral

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

Presentation findings are traced to the source above.

Rx: Pain | Main treatment

PAIN

1

PARACETAMOL

Pain

1st line

Strength500 mg

Formoral.solid

Adult dose and duration

1 g (two 500 mg tablets) 3 or 4 times daily, to a maximum of 4 g in 24 hours. - Until the joint settles after reduction; review if still needed.

Paediatric dose

15 mg/kg/dose [child max 500 mg]

(Child 1 month and over: 15 mg/kg 3 or 4 times daily, to a maximum of 60 mg/kg in 24 hours. Child under 1 month: 10 mg/kg 3 or 4 times daily, to a maximum of 40 mg/kg in 24 hours. A single dose is capped at 500 mg because the top band of MSF's own weight table, 30 to under 50 kg, is one 500 mg tablet three times daily.)

Dose by weight
3kg45 mg/dose
4kg60 mg/dose
5kg75 mg/dose
6kg90 mg/dose
7kg105 mg/dose
8kg120 mg/dose
9kg135 mg/dose
10kg150 mg/dose
11kg165 mg/dose
12kg180 mg/dose
13kg195 mg/dose
14kg210 mg/dose
15kg225 mg/dose
16kg240 mg/dose
17kg255 mg/dose
18kg270 mg/dose
19kg285 mg/dose
20kg300 mg/dose
21kg315 mg/dose
22kg330 mg/dose
23kg345 mg/dose
24kg360 mg/dose
25kg375 mg/dose
26kg390 mg/dose
27kg405 mg/dose
28kg420 mg/dose
29kg435 mg/dose
30kg450 mg/dose
31kg465 mg/dose
32kg480 mg/dose
33kg495 mg/dose
34kg500 mg/dose (capped)
35kg500 mg/dose (capped)
36kg500 mg/dose (capped)
37kg500 mg/dose (capped)
38kg500 mg/dose (capped)
39kg500 mg/dose (capped)
40kg500 mg/dose (capped)
41kg500 mg/dose (capped)
42kg500 mg/dose (capped)
43kg500 mg/dose (capped)
44kg500 mg/dose (capped)
45kg500 mg/dose (capped)
46kg500 mg/dose (capped)
47kg500 mg/dose (capped)
48kg500 mg/dose (capped)
49kg500 mg/dose (capped)
50kg500 mg/dose (capped)
Dose source

MSF Essential Drugs 2024 - paracetamol (oral)

Why

A dislocated joint is painful before, during and after reduction, and giving something for it is one of the few things primary care can do while the referral is arranged. Paracetamol is MSF's analgesic for mild to moderate pain; the amount is MSF's, because the dislocation article states none.

Cautions
  • The reduction itself is not done on paracetamol. The article states that an intra-articular anaesthetic injection - or, less often, procedural sedation - is required to relax the muscles holding the joint out. It names no drug, no strength and no volume for either, so none is printed.
  • A pulseless, pale or numb limb below the joint, an open dislocation, or a suspected spinal dislocation with cord signs goes straight out - no analgesic changes any of those.
  • Delaying reduction beyond 24 hours raises the risk of an unstable reduction, muscle spasm and neurovascular compromise, so pain relief is given on the way to reduction rather than instead of it.
  • Never exceed 4 g in 24 hours in an adult, or 60 mg/kg in 24 hours in a child. MSF warns that paracetamol poisoning is severe - it causes hepatic cytolysis - and that the stated limits matter most in children and in older patients.
  • MSF records no contra-indication in pregnancy or in breast-feeding, and names paracetamol as the analgesic of choice for a patient allergic to aspirin, one with a history of gastric trouble, a pregnant or breast-feeding woman, and children.
  • Paracetamol has no anti-inflammatory action, so it eases the pain and does nothing for the swelling.
Egyptian brands
Egyptian brandManufacturerIndicative price
FEBRIMOL 500 MG 20 TAB.PHARCO3.50 EGP (0.17/unit)
CETAMOL 500 MG 20 TABS.MEMPHIS8.00 EGP (0.40/unit)
PARACETAMOL-MUP 500MG B.P. 20 TABS.MUP13.00 EGP (0.65/unit)
CETAL 500 MG 20 TABS.EIPICO24.00 EGP (1.20/unit)
ARKADOLOW 500 MG 30 F.C. TABS.UTOPIA42.00 EGP (1.40/unit)
PARAMOL 500MG 20 TAB.MISR38.00 EGP (1.90/unit)
ADOL 500MG 24 CAPLETSJULPHAR32.00 EGP
AUGICETAMIDE 500 MG 20 SACHETSAUG PHARMA50.00 EGP
FEBRIMOL ORAL DROPS 20 ML? strength differs? different route - not oral solidPHARCO4.00 EGP
THERA-LO 3.2G/100ML ORAL SUSP. 100 ML? strength differs? different route - not oral solidPHAROPHARMA5.00 EGP

MAIN TREATMENT

2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Adult dose and duration

Traumatic joint dislocation or subluxation of any site needs prompt reduction and imaging to exclude fracture or neurovascular injury; a GP can give analgesia and immobilise before referral. - Refer, with advice

Paediatric dose

A child is dosed from the drug rows above, by weight. The referral threshold and the safety-netting are the same at any age.

Dose source

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

Why

Traumatic joint dislocation or subluxation of any site needs prompt reduction and imaging to exclude fracture or neurovascular injury; a GP can give analgesia and immobilise before referral.

Cautions
  • Neurovascular compromise distal to the joint (pulseless, pale, numb limb), open dislocation, suspected spinal dislocation with cord signs.
  • The drug rows above are what the treating service gives. They are here so that the referral is an informed one and so the GP can recognise the regimen the patient comes back on - not as permission to start it without the referral.
  • RED FLAG - Delaying reduction over 24 hours increases the risk of neurovascular compromise, muscle spasm, and unstable reduction.
  • RED FLAG - Proximal humerus fracture-dislocations with a displaced humeral head where closed reduction fails require emergent orthopedic surgical consultation for urgent open reduction.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.