Dawaa Reference

Clinical reference

Shoulder dislocation

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

Evidence status

Checked against the sources named below

Sources4 sources

ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class LD48.03 - condition scope only, no dose · Shoulder Dislocations Overview - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK459125/ · Anterior Glenohumeral Joint Dislocation - StatPearls - NCBI Bookshelf - disease-level clinical article (shoulder-dislocation-full.txt) · MSF Essential Drugs 2024 - paracetamol (oral)

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

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (1)

  • A fit or an electric shock is the history that lies behind a backward dislocation [seizures · shock]

Signs — what you find (10)

  • The head of the humerus can be seen and felt sitting abnormally far forward
  • Inspect and palpate all three joints of the shoulder complex in turn, the sternoclavicular, the acromioclavicular and the glenohumeral
  • Record the neurovascular state before attempting any reduction
  • The axillary nerve runs along the humeral neck and quadrilateral space, which is why it is the one most often hurt
  • That nerve is intact if sensation over the upper arm is preserved
  • Deltoid should fire on abduction if the nerve is working
  • Check the axillary artery by distal perfusion and pulses, with no swelling or growing haematoma in the armpit
  • In the backward type the limb is held turned inwards and will not rotate out, unlike the forward one
  • The rare downward dislocation presents with the arm stuck up in full abduction
  • More bruising than expected points to injury of soft tissue or bone [bruising]

Tests (10)

  • Every traumatic shoulder needs plain films in more than one view at the outset
  • The AP film shows displacement up and down; a view at right angles to it is needed for front-to-back displacement
  • The axillary view needs the arm abducted and is often impossible because of pain or the dislocation itself
  • The Velpeau view avoids abduction: the arm stays in a sling and the patient leans back 30 to 40 degrees over the cassette
  • A scapular Y projection settles where the humeral head lies in relation to the glenoid when other films are hard to read
  • Later films add a Stryker notch view for a Hill Sachs lesion on the humeral head and a Westpoint view for bone loss at the glenoid
  • Younger patients get an MR arthrogram for the labrum; older ones an MRI to look for a torn rotator cuff alongside
  • CT measures how much bone has gone from the humeral head or glenoid in long-standing dislocation and shapes the treatment
  • A Zanca view added to the clavicle film uses a beam tilted 30 degrees upwards
  • Which way the joint has gone must be settled on films taken before reduction

If not this — what else fits (7)

  • Backward dislocation, which is easily overlooked in the emergency department
  • Luxatio erecta, the downward variety and the least common of them
  • An isolated lesser tuberosity fracture, which should prompt a hunt for a backward dislocation
  • Acromioclavicular joint separation, some 9% of shoulder girdle injuries
  • Disruption of the sternoclavicular or acromioclavicular joint at the same time
  • Fracture of the proximal humerus, either instead of or alongside the dislocation
  • Fracture dislocation with a fully displaced head, where closed reduction usually fails and urgent surgery may be needed

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. - While the shoulder is painful, reviewed as the range of movement comes back.

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

An anterior glenohumeral dislocation hurts from the moment it happens until well after it is back in, and the article's non-operative pathway begins with symptomatic management of pain and gentle range of motion before strengthening starts. Paracetamol is the analgesic MSF indicates for mild to moderate pain and the one with fewest bars to its use in a patient who may go on to a reduction; the amount is MSF's, because the shoulder article gives 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.
  • Analgesia must not become a reason to wait. The article puts an unstable reduction, muscle spasm and neurovascular compromise on a reduction delayed beyond 24 hours.
  • Examine and record the axillary nerve - sensation over the sentinel patch and deltoid firing - and the distal pulses before any reduction attempt. Axillary nerve injury is found in about 42% of acute anterior dislocations.
  • 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

Glenohumeral dislocation is common trauma, typically anterior, from a fall or sports injury; needs reduction (often in an emergency setting), post-reduction imaging, and follow-up for recurrent instability. - 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

Glenohumeral dislocation is common trauma, typically anterior, from a fall or sports injury; needs reduction (often in an emergency setting), post-reduction imaging, and follow-up for recurrent instability.

Cautions
  • Axillary nerve injury (loss of deltoid sensation), vascular compromise of the arm, recurrent or irreducible dislocation.
  • 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 - A thorough neurovascular exam (axillary nerve - sentinel patch sensation and deltoid firing; axillary artery - distal pulses/perfusion) must be performed and documented before any reduction attempt, since axillary nerve injury occurs in about 42% of acute anterior dislocations and arterial injury, though rare, carries high morbidity if missed.
  • RED FLAG - Reduction should not be delayed beyond 24 hours - delay raises the risk of unstable reduction, muscle spasm, and neurovascular compromise.
  • RED FLAG - Suspected proximal humerus fracture-dislocation (e.g. marked ecchymosis, completely displaced humeral head) needs emergent orthopedic surgery consultation, since closed reduction is often unsuccessful and urgent open reduction may be required.
  • A shoulder dislocation that follows a seizure or an electric shock is likely to be posterior, and posterior dislocations are commonly missed at first presentation.
  • An isolated lesser tuberosity fracture on X-ray should prompt a search for an underlying posterior shoulder dislocation.
  • A patient holding the arm fixed in a hyper-abducted, overhead position has an inferior dislocation (luxatio erecta), which carries a high rate of neurovascular injury.
  • The direction of the dislocation must be confirmed radiographically before any reduction attempt.
  • The Hippocratic technique, placing a foot in the axilla as counter-traction, is no longer favoured because it risks causing brachial plexus and vascular injury.
  • After a successful reduction, repeat the neurovascular examination, confirm the position on radiographs, and immobilise the arm in a sling.
  • Acromioclavicular joint separation can be mistaken for a shoulder dislocation.
  • In a patient over 40 with recurrent instability, a rotator cuff tear is the more likely underlying cause.
  • A patient under 25 who plays contact sport should be counselled that the risk of the shoulder dislocating again is very high.

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