# Dislocation or subluxation - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - Anterior Glenohumeral Joint Dislocation - disease-level clinical article (dislocation-subluxation-clinical.txt) - MSF Essential Drugs 2024 - paracetamol (oral) ## Treatment metadata - Paracetamol — 500 mg — oral.solid - Referral & safety-netting (no drug therapy) ## Complete treatment card ```text DISLOCATION OR SUBLUXATION 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 against Anterior Glenohumeral Joint Dislocation - disease-level clinical article (dislocation-subluxation-clinical.txt), MSF Essential Drugs 2024 - paracetamol (oral) (2026-08) 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 Source StatPearls "Anterior Glenohumeral Joint Dislocation" - disease-level clinical article Status traced to the source above Rx: Pain | Main treatment PAIN 1. PARACETAMOL [1st line] Adult 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. Peds 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.) 3kg -> 45 mg/dose 4kg -> 60 mg/dose 5kg -> 75 mg/dose 6kg -> 90 mg/dose 7kg -> 105 mg/dose 8kg -> 120 mg/dose 9kg -> 135 mg/dose 10kg -> 150 mg/dose 11kg -> 165 mg/dose 12kg -> 180 mg/dose 13kg -> 195 mg/dose 14kg -> 210 mg/dose 15kg -> 225 mg/dose 16kg -> 240 mg/dose 17kg -> 255 mg/dose 18kg -> 270 mg/dose 19kg -> 285 mg/dose 20kg -> 300 mg/dose 21kg -> 315 mg/dose 22kg -> 330 mg/dose 23kg -> 345 mg/dose 24kg -> 360 mg/dose 25kg -> 375 mg/dose 26kg -> 390 mg/dose 27kg -> 405 mg/dose 28kg -> 420 mg/dose 29kg -> 435 mg/dose 30kg -> 450 mg/dose 31kg -> 465 mg/dose 32kg -> 480 mg/dose 33kg -> 495 mg/dose 34kg -> 500 mg/dose (capped) 35kg -> 500 mg/dose (capped) 36kg -> 500 mg/dose (capped) 37kg -> 500 mg/dose (capped) 38kg -> 500 mg/dose (capped) 39kg -> 500 mg/dose (capped) 40kg -> 500 mg/dose (capped) 41kg -> 500 mg/dose (capped) 42kg -> 500 mg/dose (capped) 43kg -> 500 mg/dose (capped) 44kg -> 500 mg/dose (capped) 45kg -> 500 mg/dose (capped) 46kg -> 500 mg/dose (capped) 47kg -> 500 mg/dose (capped) 48kg -> 500 mg/dose (capped) 49kg -> 500 mg/dose (capped) 50kg -> 500 mg/dose (capped) 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. Caution 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. Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) CETAL 500 MG 20 TABS. EIPICO 24.00 EGP (1.20/unit) ARKADOLOW 500 MG 30 F.C. TABS. UTOPIA 42.00 EGP (1.40/unit) PARAMOL 500MG 20 TAB. MISR 38.00 EGP (1.90/unit) ADOL 500MG 24 CAPLETS JULPHAR 32.00 EGP AUGICETAMIDE 500 MG 20 SACHETS AUG PHARMA 50.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid MAIN TREATMENT 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult 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 Peds A child is dosed from the drug rows above, by weight. The referral threshold and the safety-netting are the same at any age. 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. Caution 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. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)