Anterior Shoulder Dislocation - ED Management

The shoulder is the most commonly dislocated major joint, 95% of shoulder dislocations occur anteriorly. Here’s a quick summary.  

• Most common major joint dislocation, 95% of shoulder dislocations occur anteriorly 

• Mechanism: Blow to abducted, externally rotated, extended arm 

• Exam: Loss of rounded appearance of shoulder; held in slight abduction & external rotation, resist movement 

• Possible associated injuries: Axillary nerve injury (40%, loss of sensation over deltoid), Hill-Sachs deformity (35-40%, cortical depression in the humeral head), greater tuberosity fracture (10%), bony Bankart lesions (5%, fracture of anterior inferior glenoid) 

• ED Management: Analgesia with intraarticular injection +/- procedural sedation and reduction 

• Splint: Sling-and-swath or shoulder immobilizer 

• Ortho consult: No (unless fracture, neurovascular injury, difficult reduction) 

• Disposition: DC with ortho follow-up within I week 



MH/CCF/CWRU EM Res @MetroHealth_EM



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