# Shoulder dislocation - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - Anterior Glenohumeral Joint Dislocation - StatPearls - NCBI Bookshelf - disease-level clinical article (shoulder-dislocation-full.txt) - MSF Essential Drugs 2024 - paracetamol (oral) ## Treatment metadata - Paracetamol — 500 mg — oral.solid - Referral & safety-netting (no drug therapy) ## Complete treatment card ```text SHOULDER DISLOCATION 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 against 2 sources listed above (2026-08) 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 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. - While the shoulder is painful, reviewed as the range of movement comes back. 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 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. 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. 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. 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 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 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 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. Caution 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. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)