{ "schema_version": 1, "kind": "condition", "id": "shoulder-dislocation", "name": "Shoulder dislocation", "category": "chronic", "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)", "review_status": "reviewed", "verified_against": "Anterior Glenohumeral Joint Dislocation - StatPearls - NCBI Bookshelf - disease-level clinical article (shoulder-dislocation-full.txt) · MSF Essential Drugs 2024 - paracetamol (oral)", "verified_date": "2026-08", "treatments": [ { "id": 1691, "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": "While the shoulder is painful, reviewed as the range of movement comes back.", "dose_source": "MSF Essential Drugs 2024 - paracetamol (oral)", "rationale": "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." ], "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": "shoulder-dislocation" }, { "id": 1692, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "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.", "adult_duration": "Refer, with advice", "dose_source": "No dose - referral pathway, no medicine given in primary care", "rationale": "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." ], "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": "shoulder-dislocation" } ] }