Shoulder Dislocation in Emergency Medicine 

Updated: Nov 29, 2018
Author: Sharon R Wilson, MD; Chief Editor: Trevor John Mills, MD, MPH 

Overview

Practice Essentials

The shoulder is the most frequently dislocated joint. It moves almost without restriction but pays the price of stability. The shoulder's integrity is maintained by the glenohumeral joint capsule, the cartilaginous glenoid labrum (which extends the shallow glenoid fossa), and muscles of the rotator cuff. Most dislocations are anterior, but less frequently, posterior, inferior (luxatio erecta), superior, and intrathoracic dislocations are also possible.[1, 2, 3] Arthroscopic stabilization is performed in nearly 90% of shoulder stabilization surgeries in the United States.[4]  Patients with shoulder dislocation generally complain of severe shoulder pain and an associated decreased range of motion of the affected extremity.[5]

Shoulder dislocations constitute up to 50% of all major joint dislocations. Anterior dislocations occur in as many as 97% of cases.[6] Anterior displacement of the humeral head is the most common dislocation seen by emergency physicians and is depicted in the image below.

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

Posterior displacement is the next most frequently occurring dislocation (2-4%). Inferior (luxatio erecta), superior, and intrathoracic dislocations are rare (< 1%)and are usually associated with complications.[6, 7, 8, 9]

Anterior dislocation is characterized by subcoracoid position of the humeral head in the anteroposterior (AP) view. The dislocation is often more obvious in a scapular view, where the humeral head lies anterior to the "Y." In an axillary view, the "golf ball" (ie, humeral head) is said to have fallen anterior to the "tee" (ie, glenoid). In posterior dislocation, the AP view may show a normal walking stick contour of the humeral head, or it may resemble a light bulb or ice cream cone, depending on the degree of rotation. The scapular "Y" view reveals the humeral head behind the glenoid (the center of the "Y"). Arteriography, angiography, and Doppler flow studies may be used to evaluate suspected vascular injury. Electromyography (EMG) may be used later to evaluate nerve injuries.[10]

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.

For excellent patient education resources, visit eMedicineHealth's First Aid and Injuries Center. Also, see eMedicineHealth's patient education article Shoulder Dislocation.

Epidemiology

In the United States, the incidence of shoulder dislocations is 23.9 per 100,000 person years, and approximately 85-98% of shoulder dislocations are anterior dislocations. Dislocated shoulders tend to occur more often in males than in females. In males, the peak age of incidence is 20-30 years (with a male-to-female ratio of 9:1),  and in females it is 61-80 years (with a female-to-male ratio of 3:1). The incidence of proximal humerus fractures increases with age, with a population-adjusted incidence of 101 per 100,000 person years in those older than 65 years.[11]

Shoulder dislocation occurs more frequently in adolescents than in younger children because the weaker epiphyseal growth plates in children tend to fracture before dislocation occurs. In older adults, collagen fibers have fewer cross-links, making the joint capsule and supporting tendons and ligaments weaker and dislocation more likely. Anterior dislocation is most commonly seen in those aged 18-25 years resulting from sporting injury. The second most common age group to sustain anterior dislocation is the elderly, because of their susceptibility to falls.[11]

In a study of shoulder dislocation data from the High School Reporting Information Online (RIO) and the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP) databases, high school athletes were found to have an overall shoulder dislocation rate of 2.04 per 100,000 athletic exposures, and college athletes had an overall injury rate of 2.58 per 100,000 athletic exposures. Surgery was performed in 28% of high school shoulder dislocations and 29.6% of college shoulder dislocations.[12]

Congenital dislocation of the shoulder is a very rare condition, and the dislocation of the glenohumeral joint in infants is usually associated with a fracture or a neurologic problem (eg, brachial plexus injury). If there is no history of trauma or a brachial plexus injury, congenital dislocation should be considered as a possible diagnosis.[13]

A Danish study estimated the incidence of shoulder dislocation at 17 cases per 100,000.[14]  In a random sample of people in Sweden, 1.7% reported a history of shoulder dislocation.[15]  A Greek study examined the demographic data and recurrence rates of shoulder dislocations of 308 patients (170 men and 138 women) and found that the most frequent mechanism of injury was falling, and 92% of reductions were in the ED. The overall recurrence rate in all age groups was 50% but rose to almost 89% in the 14- to 20-year-old age group.[4]

 

Prognosis

Age is a major factor in the likelihood of sustaining a recurrent shoulder dislocation.[16]  Approximately 80-94% of patients younger than 20 years at the time of the initial dislocation have a recurrence. The major pathology in this age group is thought to be a Bankart lesion with associated inferior glenohumeral ligament injury.

Of patients younger than 40 years, 26-48% develop recurrent dislocation. The major pathology for this age group is thought to be disruption of the labral attachment of the glenohumeral ligaments. Dislocation recurs in only 0-10% of patients older than 40 years. Rotator cuff tear is the major pathology.

Minor trauma that results in a dislocation is associated with an 86% recurrence rate. Many orthopedic surgeons believe that more than one complete anterior dislocation justifies considering surgical repair.

There is general agreement that before being allowed to return to sports after anterior shoulder dislocation, athletes should be pain free and should demonstrate symmetric shoulder and bilateral scapular strength with functional range of motion. Usually, returning to play can occur 2-3 weeks after  dislocation; however, athletes with in-season shoulder injury who return to play during the season have demonstrated recurrence rates of 37-90%.[17, 18]

 

Presentation

History

Patients with shoulder dislocation generally complain of severe shoulder pain and an associated decreased range of motion of the affected extremity.[5]

Mechanisms of injury are usually traumatic but may vary. Mechanisms may include sports, assaults, falls, seizures, throwing an object, reaching to catch an object, forceful pulling on the arm, reaching for an object, turning over in bed, or combing hair.

Patients may have a history of recurrent ED visits for the same complaint.

Specific mechanisms or historical facts may be suggestive of certain types of dislocations, such as lightning injuries, electrical injuries, and seizure with posterior dislocations; throwing a ball or a punch or forceful pulling of the arm with an anterior dislocation; and axial loading of an extremely abducted arm with inferior dislocation.

Shoulder instability can result from repetitive microtrauma in overhead-throwing athletes, such as baseball, tennis, and volleyball players and swimmers,  as the glenohumeral joint often exceeds its physiologic limit.[18]

Congenital dislocation of the shoulder is a very rare condition, and the dislocation of the glenohumeral joint in infants is usually associated with a fracture or a neurologic problem (eg, brachial plexus injury). If there is no history of trauma or a brachial plexus injury, congenital dislocation should be considered as a possible diagnosis.[13]

Physical

Anterior shoulder dislocation (95-98% of ED dislocations):

  • Arm is held in slight abduction and external rotation.

  • Shoulder is "squared off" (ie, boxlike) with loss of deltoid contour compared with contralateral side.

  • Humeral head is palpable anteriorly (subcoracoid region, beneath the clavicle).

  • Patient resists abduction and internal rotation and is unable to touch the opposite shoulder.

  • Compare bilateral radial pulses to help rule out vascular injury.

  • In all cases, evaluate the axillary nerve before and after reduction by testing both pinprick sensation in the "regimental badge" area of the deltoid and palpable contraction of the deltoid during attempted abduction. Evaluate sensory and motor function of the musculocutaneous and radial nerves.

Posterior shoulder dislocation (3% of ED shoulder dislocations):

  • Arm is held in adduction and internal rotation.

  • Anterior shoulder is "squared off" and flat with prominent coracoid process. Shoulders may look identical in bilateral dislocation, making it a commonly missed injury.

  • Posterior shoulder is full with humeral head palpable beneath the acromion process.

  • Patient resists external rotation and abduction.

  • Neurovascular deficits are infrequent.

Inferior (luxatio erecta) shoulder dislocation (0.5% of ED dislocations)[19] :

  • Arm is fully abducted with elbow commonly flexed on or behind head.

  • Humeral head may be palpable on the lateral chest wall.

Causes

Anterior shoulder dislocations usually result from abduction, extension, and external rotation, such as when preparing for a volleyball spike.[18] Falls on an outstretched hand are a common cause in older adults. The humeral head is forced out of the glenohumeral joint, rupturing or detaching the anterior capsule from its attachment to the head of the humerus or from its insertion to the edge of the glenoid fossa. This occurs with or without lateral detachment.

Posterior dislocations are caused by severe internal rotation and adduction. This type of dislocation usually occurs during a seizure, a fall on an outstretched arm, or electrocution. Occasionally, a severe direct blow may cause a posterior dislocation. Bilateral posterior dislocation is rare and almost always results from seizure activity. Misinterpretation of the radiograph appearance of a posterior dislocation may result in misdiagnosis as a soft tissue injury in up to 79% of cases.

Rare, but serious, inferior dislocations (luxatio erecta) may be due to axial force applied to an arm raised overhead, such as when a motorcycle collision victim tumbles to the ground. More commonly, the shoulder is dislocated inferiorly by indirect forces hyperabducting the arm. The neck of the humerus is levered against the acromion and the inferior capsule tears as the humeral head is forced out inferiorly. Luxatio erecta almost always has an associated fracture or soft-tissue injury. One series found 80% of patients to have fracture of the greater tuberosity or tear of the rotator cuff. Neurologic compromise was found in 60% of patients, with the axillary nerve the most commonly injured nerve. Inferior dislocations have the highest incidence (3.3%) of vascular compromise.

Complications

Complications include shoulder dislocation, soft tisue injuries, nerve injuries, and vascular injuries.[20, 21, 22, 23, 16, 24, 25]

Fractures and soft-tissue injuries

Hill-Sachs lesions occur when the edge of the glenoid causes an impaction fracture in the posterolateral aspect of the humeral head during anterior dislocation and in the anterolateral aspect in posterior dislocation (referred to as a "reverse Hill-Sachs" lesion).

A Bankart lesion is fracture of the anterior rim of the glenoid labrum associated with joint capsule rupture and inferior glenohumeral ligament injury. Significantly displaced anterior or posterior glenoid rim fractures require operative management. Most initial shoulder dislocations produce a Bankart lesion, particularly in younger patients.

Fracture of the greater tuberosity, acromion, coracoid, clavicle, and humeral neck also occur.

Rotator cuff traction injury is most common in elderly patients and in association with inferior dislocations. This is a commonly missed injury, with an average time of 7 months from injury to diagnosis of rotator cuff rupture in patients older than 40 years.

Patients who experience anterior shoulder dislocation are at increased risk for glenohumeral arthropathy. Average overall T1p values on MRI for humeral head cartilage in dislocated shoulders have been shown to be significantly greater than that in control patients.[25]

Nerve injury

Approximately 3% (and higher in some series) of dislocations involve injury to the axillary nerve. Injury may resolve spontaneously or require surgical exploration and possible nerve grafting.

Patients exhibit numbness in the area of the deltoid muscle and weakness with abduction and external rotation.

Axillary nerve injury does not change initial treatment, but pre-reduction and post-reduction neurologic examinations are important.

Radial nerve injury should also be determined. The axillary and radial nerves both arise from the posterior cord. The thumb, wrist, and elbow will be weak on extension, and the dorsal hand will be numb.

Vascular injury

Axillary artery injuries are rare but have been reported to occur with anterior, inferior, and intra-thoracic dislocations. Especially susceptible are older adults with atherosclerotic axillary arteries. Arterial injury may be associated with decreased radial pulse.

Lateral chest wall ecchymosis with associated axillary hematoma and bruit may be noted on physical examination.

Angiography should be considered with any brachial plexus injury.

 

DDx

Diagnostic Considerations

Associated fractures occur in approximately 30% of shoulder dislocations. The most common fractures include the Hill Sachs lesion, which is a compression fracture that results in the formation of a groove in the posterolateral aspect of the humeral head. This lesion is seen in 54-76% of dislocations. The Bankart lesion is a fracture of the anterior rim of the glenoid fossa. This lesion results from impaction of the humeral head against the anteroinferior glenoid labrum. It is associated with rupture of the joint capsule and inferior glenohumeral ligament injury. Avulsion fractures of the greater tuberosity are seen in 10-16% of cases. Humeral shaft and coracoid process fractures are rare.

The rotator cuff is injured in 35-86% of dislocations and is more commonly seen in elderly patients. Glenohumeral ligament injury occurs in approximately 55% of cases and is most common in young patients. The axillary nerve is injured in 3% of anteroinferior dislocations. It is the most frequently injured, but brachial plexus, radial, and other nerve injury can occur.

If a brachial plexus injury is diagnosed, axillary artery injury, although rare, should be considered. Patients with axillary artery rupture present with axillary hematoma, a cool limb, and absent pulses. However, patients with collateral blood flow may have distal pulses. Luxatio erecta has the highest incidence of vascular compromise. Evaluation of vascular injury should include Doppler blood flow studies, angiography, and arteriography.

Differential Diagnoses

 

Workup

Imaging Studies

Radiographs

Anterior dislocation is characterized by subcoracoid position of the humeral head in the anteroposterior (AP) view. Management of anterior shoulder dislocation starts with an analysis of the causative mechanism and a physical exam to establish the diagnosis, and the case can be classified as simple or accompanied by complications (most notably vascular or nerve injuries). Two radiographs perpendicular to each other can confirm the diagnosis and should then be repeated after reduction. Additional imaging studies may be necessary to assess bony lesions (eg, impaction lesions or fractures).[26, 27]

The dislocation is often more obvious in a scapular view, where the humeral head lies anterior to the "Y." In an axillary view, the "golf ball" (ie, humeral head) is said to have fallen anterior to the "tee" (ie, glenoid). In posterior dislocation, the AP view may show a normal walking stick contour of the humeral head, or it may resemble a light bulb or ice cream cone, depending upon the degree of rotation. The scapular "Y" view reveals the humeral head behind the glenoid (the center of the "Y"). In an axillary view, the "golf ball" falls posteriorly off the "tee."[20, 28, 29]  In inferior dislocation (luxatio erecta), the AP view may show the arm raised over the head with the radial head inferior to the glenoid.

Prereduction films are commonly performed to document the nature of the dislocation and to establish the existence of any associated pathology, such as a Hill-Sachs lesion or other humeral fractures. In cases where patients have experienced repeated anterior dislocations, prereduction films may not be necessary prior to attempts at reduction.[30]

Postreduction films confirm relocation of the humerus and may reveal new or previously obscured pathology. Postreduction immobilization is imperative. A prospective observational study examined whether postreduction radiographs add clinically important information to what is seen on prereduction radiographs in patients with anterior shoulder dislocations who are seen in the ED. The authors found that, although most fractures (62.5%) were seen on prereduction radiographs, more than one third (37.5%) were only visible on postreduction films. None of the missed fractures changed ED management, and no persistent dislocations were found on postreduction films.[31]

Other imaging

Arteriography, angiography, and Doppler flow studies may be used to evaluate suspected vascular injury. Electromyography (EMG) may be used later to evaluate nerve injuries.[10]

In a study of computed tomography for the detection of Hill-Sachs lesions, 142 shoulders were evaluated preoperatively by CT (30 with primary instability and 112 with recurrent instability) before arthroscopic Bankart repair. Hill-Sachs lesions were detected in 90 shoulders by initial CT evaluation and were found in 118 shoulders at arthroscopy. In patients with primary subluxation, the prevalence of Hill-Sachs lesions was 26.7%; primary dislocation, 73.3%; and all shoulders, 56.3%. In patients with recurrent episodes of complete dislocation, the prevalence of Hill-Sachs lesions was increased, and the lesions were larger.[21]

Horst et al used magnetic resonance imaging to identify the correlation between Bankart and Hill-Sachs lesions in 105 patients with anterior shoulder dislocation. They found that the co-occurrence of injuries was high [odds ratio (OR) = 11.47; 95% confidence interval (CI) = 3.60-36.52; P< 0.001] and that Bankart lesions co-occurred more often with large Hill-Sachs lesions (O  = 1.24; 95% CI = 1.02-1.52; P = 0.033). In addition, patients older than 29 years more often presented with a bilateral injury (OR = 16.29; 95% CI = 2.71-97.73; p = 0.002). If either lesion was diagnosed, the patient was 11 times more likely to have suffered the associated injury.[22]

Magnetic resonance angiography has been shown to have a high sensitivity when used to identify associated injuries in shoulder dislocation.[32]

In a study of point-of-care ultrasonography for shoulder dislocation in emergency departments, sensitivity and specificity for identifying dislocation were both 100%. For excluding shoulder fracture, point-of-care ultrasound had a sensitivity of 100% and a specificity of 84.2%.[33]

 

Treatment

Approach Considerations

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.[34, 23]

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.[35]

Immobilize the shoulder after reduction.

Perform careful prereduction and postreduction neurovascular examinations.

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.

Emergency Department Care

The key to a successful reduction is slow and steady application of a maneuver with adequate analgesia and relaxation. Procedural sedation and analgesia (PSA) protocols in the ED assist in relaxing the musculature of the shoulder and make reduction a more comfortable and easier procedure. (For further information, see Procedural Sedation.)

Other adjuncts to facilitate reduction for patients who are high risk or may not be candidates for PSA include intra-articular lidocaine and ultrasound-guided interscalene (lidocaine) block of the brachial plexus.

Successful reduction is evidenced by marked reduction in pain and increased range of motion. A palpable or audible relocation ("clunk") may also be noted. The patient may be asked to touch the uninjured shoulder to safely demonstrate a successful reduction.

Some authors recommend an orthopedic consultation prior to reduction of posterior and inferior dislocations.

After the completion of all reductions, apply a shoulder immobilizer with a sling and swathe. A careful neurovascular examination must be performed prereduction and postreduction. Post-reduction radiography is still recommended, especially if the procedure was difficult.

Inappropriate traction and poor technique can result in complications with otherwise safe methods of reduction. The Kocher method has been discouraged because of the increased incidence of complications.[6] When performed correctly, it does not involve traction and has been demonstrated to be a safe technique. (For further information, see Joint Reduction, Shoulder Dislocation, Anterior.) In Kocher's original method, bend the arm at the elbow, press it against the body, rotate outwards until resistance is felt. Lift the externally rotated upper part of the arm in the sagittal plane as far as possible forwards and finally turn inwards slowly.

The Stimson technique requires that the patient lie prone on the bed with the dislocated arm hanging over the side. Traction is provided by up to 5-15 kg of weight attached to the wrist or above the elbow. Apply gentle internal/external humeral rotation. Reduction may take 20-30 minutes.[6]

In the external rotation method, while the patient lies supine, adduct the arm and flex it to 90° at the elbow. Slowly rotate the arm externally, pausing for pain. Reduce the shoulder before reaching the coronal plane. Often successful, this procedure requires only one physician and little force. Reduction usually occurs with the arm externally rotated between 70 and 110 degrees.[6]

For traction-countertraction, while the patient lies supine, apply axial traction to the arm with a sheet wrapped around the forearm and the elbow bent at 90°. An assistant should apply countertraction using a sheet wrapped under the arm and across the chest while the shoulder is gently rotated internally and externally to disengage the humeral head from the glenoid.[6]

Scapular rotation is a less traumatic technique and has success rates of more than 90% in experienced hands, often without sedation. With the patient lying prone, apply manual traction or 5-15 lb of hanging weight to the wrist. After relaxation, rotate the inferior tip of the scapula medially and the superior aspect laterally. Alternatively, the patient can be seated while an assistant provides traction-countertraction by pulling on the wrist with one hand and bracing the upper chest with the other. The same scapular rotation is then performed.[6]

For reduction of a posterior dislocation, apply gentle, prolonged axial traction on the humerus. Then, add gentle anterior pressure while coaxing the humeral head over the glenoid rim. Slow external rotation may be needed.

For reduction of an inferior dislocation, maintain gentle axial traction on the humerus while gentle abduction is applied. Apply countertraction across the ipsilateral shoulder. Following reduction, slowly adduct the arm. Buttonholing of the humeral head through the capsule usually requires open reduction.

Medical Care

After procedural sedation with longer-acting sedating agents (eg, midazolam), the patient with shoulder dislocation should be observed for the necessary period and then discharged in the care of family or friends. Patients who require operative reduction and repair should be admitted by the orthopedic surgery service.

Arrange orthopedic follow-up in 5-7 days. The patient's shoulder should remain in the immobilizer until his or her orthopedic clinic appointment.

Primary surgical repair of initial acute traumatic shoulder dislocations in young adults engaged in highly demanding physical activities (eg, sports, military) is supported by a Cochrane Database Systematic Review of 5 randomized, controlled studies.[36] Subsequent shoulder instability was significantly less frequent in the surgical group (relative risk, 0.20; 95% CI, 0.11-0.33), with half of the conservatively treated patients opting for subsequent surgery. Functional assessment measures of the shoulder were also more favorable in those treated surgically. Since this demographic group is at far greater risk of recurrent dislocation, these results cannot be generalized to other groups.

 

Medication

Medication Summary

Opiate analgesia should be given as needed for pain in patients with shoulder dislocation. Intravenous or intramuscular medications, intra-articular injections, and regional anesthetic techniques have been reported as successful aides for reduction of shoulder dislocations.

Procedural sedation and analgesia (PSA) is commonly used to achieve adequate pain control and muscle relaxation for reduction. A randomized, controlled trial of 30 patients compared intra-articular lidocaine with PSA (morphine and midazolam).[37] All patients who received intra-articular injections obtained adequate analgesia and muscle relaxation, were free of complications, and had significantly shorter emergency department stays (78 min vs 186 min; P=0.004).[37] A Cochrane Database of Systematic Review of 113 patients with acute anterior shoulder dislocation who underwent intra-articular lidocaine injection and 98 patients who underwent intravenous analgesia with sedation found that intra-articular lidocaine injection may be associated with fewer side effects and a shorter stay in the ED and may be less expensive than intravenous medication.[38]

Etomidate, fentanyl/midazolam, ketamine, or propofol is commonly used for PSA. Some ED physicians prefer etomidate because of its rapid onset (< 30 sec), short duration (about 5 min), and excellent muscle relaxation. Other physicians consider propofol superior in terms of side effects and duration. Propofol's high lipid solubility results in a rapid onset (30-60 sec) and a short plasma half-life (1.3-4.1 min). The result is a rapid decline of propofol concentrations, rapid awakening, and shorter recovery times.

An ED-based study evaluated the combination of propofol and remifentanil for sedation to reduce anterior shoulder dislocations.[39] Eleven patients were given propofol 0.5 mg/kg and remifentanil 0.5 mcg/kg IV over 90 seconds. Further doses of propofol 0.25 mg/kg and remifentanil 0.25 mcg/kg were administered if needed. All patients had adequate sedation and analgesia within 3 minutes. Mean time to achieve reduction after dosage was 1.6 minutes, and mean time to being clinically alert was 3 minutes. However, postreduction time in the ED ranged from 30-312 minutes. Rapid recovery was a marked feature of this study. All patients became alert quickly and were ambulatory without assistance in less than 30 minutes.

Analgesics

Class Summary

These agents may be used for the relief of pain and relaxation of shoulder muscles. Pain control is essential to quality patient care. It ensures patient comfort, improves likelihood of successful reduction, and aids physical therapy regimens. Many analgesics have sedating properties that benefit patients with injuries.

Fentanyl citrate (Duragesic, Sublimaze)

DOC because of its rapid, almost immediate onset and short duration of 30-60 min. Can be reversed easily by naloxone 2 mg IV as needed for respiratory depression. Often used as part of conscious sedation with midazolam (see Sedation). Useful for emergency department visits only. Not intended to be given on an outpatient basis.

Oxycodone and acetaminophen (Percocet)

Drug combination indicated for relief of moderately severe to severe pain.

Hydrocodone bitartrate and acetaminophen (Vicodin ES)

Drug combination indicated for relief of moderately severe to severe pain.

 

Questions & Answers

Overview

What is shoulder dislocation?

What is the prevalence of shoulder dislocation?

What is the prognosis of shoulder dislocation?

Presentation

Which clinical history findings are characteristic of shoulder dislocation?

Which physical findings are characteristic of anterior shoulder dislocation?

Which physical findings are characteristic of posterior shoulder dislocation?

Which physical findings are characteristic of inferior shoulder dislocation?

What causes shoulder dislocation?

What are the possible complications of shoulder dislocation?

How are fractures and soft-tissue injuries diagnosed and treated in patients with shoulder dislocation?

How is an axillary nerve injury diagnosed and treated in patients with shoulder dislocation?

How are vascular injuries diagnosed and treated in patients with shoulder dislocation?

DDX

What is the prevalence of comorbid fractures and soft-tissue injuries in shoulder dislocations?

What are the differential diagnoses for Shoulder Dislocation in Emergency Medicine?

Workup

What is the role of radiography in the diagnosis of shoulder dislocation?

What is the role of imaging studies in the workup of shoulder dislocation?

Treatment

How are shoulder dislocations treated?

What is reduction performed for the treatment of shoulder dislocation?

What is the role of traction-countertraction in the treatment of shoulder dislocation?

What is included in the treatment of shoulder dislocation following reduction?

What is the role of surgery in the treatment of shoulder dislocation?

Medications

Which medications are used in the treatment of shoulder dislocation?

Which medications in the drug class Analgesics are used in the treatment of Shoulder Dislocation in Emergency Medicine?