{ "schema_version": 1, "kind": "condition", "id": "dislocation-subluxation", "name": "Dislocation or subluxation", "category": "chronic", "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)", "review_status": "reviewed", "verified_against": "Anterior Glenohumeral Joint Dislocation - disease-level clinical article (dislocation-subluxation-clinical.txt) · MSF Essential Drugs 2024 - paracetamol (oral)", "verified_date": "2026-08", "treatments": [ { "id": 622, "generic": "Paracetamol", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 500.0, "adult_dose": "1 g (two 500 mg tablets) 3 or 4 times daily, to a maximum of 4 g in 24 hours.", "adult_duration": "Until the joint settles after reduction; review if still needed.", "dose_source": "MSF Essential Drugs 2024 - paracetamol (oral)", "rationale": "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." ], "peds_mgkg_low": 15.0, "peds_mgkg_high": 15.0, "peds_max_mg": 500.0, "peds_basis": "dose", "peds_unit": "mg", "peds_note": "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.", "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": [ { "weight_kg": 10, "low_mg": 150, "high_mg": 150, "capped": false }, { "weight_kg": 20, "low_mg": 300, "high_mg": 300, "capped": false }, { "weight_kg": 30, "low_mg": 450, "high_mg": 450, "capped": false }, { "weight_kg": 40, "low_mg": 500, "high_mg": 500, "capped": true } ], "brands": [ { "trade_name": "FEBRIMOL 500 MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 3.5, "pack_count": 20, "unit_price": 0.17, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CETAMOL 500 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 8.0, "pack_count": 20, "unit_price": 0.4, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PARACETAMOL-MUP 500MG B.P. 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 13.0, "pack_count": 20, "unit_price": 0.65, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CETAL 500 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 24.0, "pack_count": 20, "unit_price": 1.2, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ARKADOLOW 500 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UTOPIA", "price_egp": 42.0, "pack_count": 30, "unit_price": 1.4, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PARAMOL 500MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR", "price_egp": 38.0, "pack_count": 20, "unit_price": 1.9, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ADOL 500MG 24 CAPLETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "JULPHAR", "price_egp": 32.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AUGICETAMIDE 500 MG 20 SACHETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AUG PHARMA", "price_egp": 50.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FEBRIMOL ORAL DROPS 20 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 4.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "THERA-LO 3.2G/100ML ORAL SUSP. 100 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHAROPHARMA", "price_egp": 5.0, "pack_count": null, "unit_price": null, "strength_mg": 3200.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "dislocation-subluxation" }, { "id": 623, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "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.", "adult_duration": "Refer, with advice", "dose_source": "No dose - referral pathway, no medicine given in primary care", "rationale": "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "A child is dosed from the drug rows above, by weight. The referral threshold and the safety-netting are the same at any age.", "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": "dislocation-subluxation" } ] }