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Shoulder Dislocation in Emergency Medicine Treatment & Management

  • Author: Sharon R Wilson, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
 
Updated: Sep 15, 2015
 

Prehospital Care

In patients with shoulder dislocation, stabilize and treat associated trauma as indicated. Allow the patient to assume a position of comfort while maintaining cervical spine immobilization if necessary. A pillow between the patient's arm and torso may increase comfort.[18, 19]

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Emergency Department Care

Administer analgesics to decrease pain.

Prereduction and postreduction radiographs are recommended. Patients with frequent recurrent dislocations can safely avoid radiographs.

Procedural sedation and analgesia (PSA) protocols, intra-articular lidocaine, and ultrasound-guided brachial plexus nerve block assist in making reduction an easier and more comfortable procedure. Using US-guided interscalene block reduces time spent in the ED and lessens one-on-one health care provider time compared to procedural sedation.[20]

Immobilize the shoulder after reduction.

Perform careful prereduction and postreduction neurovascular examinations.

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Consultations

Orthopedic consultation may be helpful for dislocations with concomitant fractures, for posterior or inferior dislocations, and for cases in which the patient's shoulder cannot be reduced in a timely fashion.

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Contributor Information and Disclosures
Author

Sharon R Wilson, MD Assistant Professor of Emergency Medicine, Department of Emergency Medicine, University of California at Davis Medical Center

Sharon R Wilson, MD is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine, American Association of University Women

Disclosure: Nothing to disclose.

Coauthor(s)

Daniel D Price, MD Director of International Ultrasound, Department of Emergency Medicine, Alameda County Medical Center, Highland Hospital and Trauma Center

Daniel D Price, MD is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Trevor John Mills, MD, MPH Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine

Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Additional Contributors

James E Keany, MD, FACEP Associate Medical Director, Emergency Services, Mission Hospital Regional Medical Center, Children's Hospital of Orange County at Mission

James E Keany, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, California Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Tom Scaletta, MD President, Smart-ER (http://smart-er.net); Chair, Department of Emergency Medicine, Edward Hospital; Past-President, American Academy of Emergency Medicine

Tom Scaletta, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

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Y-view radiograph of the right shoulder shows anterior dislocation of the humeral head relative to the glenoid fossa.
 
 
 
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