Last Updated on August 19, 2026
Introduction
A common type of dislocation seen in ED, especially anterior shoulder dislocation
Types:
• Anterior dislocation (95%)
• Posterior dislocation (≈4%)
• Inferior dislocation
Clinical Features
Mechanism of injury
• Patient had a fall due to seizure / accident
Presentation
• Patient complained of extreme pain over affected shoulder
Physical examination
Features of anterior dislocation i.e. loss of deltoid contour in regimental badge area
• Affected shoulder appears ‘
squared off
• Fullness of anterior shoulder
Examine for potential complications
•
Axillary nerve sensation
• Radial nerve function
• Pulses at wrist
Complications
-
Axillary nerve injury
×
Check for sensation at regimental badge area
- Radial nerve injury (rare)
- Brachial plexus injury (rare)
- Axillary artery transection (rare)
-
Bankart lesion
×
Anterior inferior glenoid labrum tear
-
Recurrence
×
e.g. more than 3 times will require orthopaedic outpatient referral
Investigation
X-rays
• Shoulder X-ray: AP view and scapular Y-view of affected side, to look for type of dislocation and presence of fracture PRIOR to CMR Hill Sachs lesion Further reading
=====
Other findings:
•
Hill Sachs lesion
• Compression fracture of posterolateral aspect of humeral head
• May be seen in patients with previous anterior shoulder dislocation of the same side
https://radiopaedia.org/articles/hill-sachs-defect
CT scan
• Done in fracture-dislocation, to assess fracture configuration as pre-op planning
Management of anterior shoulder dislocation — CMR Under PSA
Prior to procedure
• Consent
• Examination and documentation of axillary nerve, radial nerve and pulses at wrist
• Preparation for procedural sedation analgesia
Methods of reduction
• Kocher’s manoeuvre [Video 1] [Video 2] [Video 3] Stimson's Technique (modified) ✎Patient prone on table with affected limb hanging freely over edges, the dislocated shoulder could be reduced for at least 10 - 15 minutes, PROVIDED patient must be fully sedated and muscles must be fully relaxed ===== =====
• Cooper Milch technique
•
Stimson
Disadvantages:
✎Prolonged duration of sedation is required
✎Difficult choice of PSA
• Respiratory inhibition VS reduction of dislocated joint
• e.g. propofol may not be a suitable PSA
✎Difficult monitoring in prone position
✎Respiratory inhibition from sedation will be amplified by prone position
Further reading:
https://www.msdmanuals.com/professional/injuries-poisoning/how-to-reduce-dislocations-and-subluxations/how-to-reduce-anterior-shoulder-dislocations-using-the-stimson-technique
• Countertraction technique
• Hippocratic manoeuvre
• Cunnigham method
• Spaso technique
Post-procedure
• Recheck neurovascular status of affected upper limb • Keep for at least 2 weeks (if severe, the duration of immobilization could be longer e.g. up to 6 weeks) • e.g. Left shoulder AP and scapular Y-view • Method used Abbreviation: XOA e.g. For assessment of fracture healing during appointment in a previously reduced fracture
• Immobilization – Apply
collar and cuff and strappings
• Strappings – keep the affected shoulder in adduction e.g. by using Hypafix®
• For soft tissues to heal / oedema to subside, to prevent recurrence
•
Check X-ray post CMR
• To look for reduction of shoulder joint and evidence of fracture post CMR
•
Documentation
• Type of PSA given
• Post-procedure examination findings especially axillary nerve, radial nerve and pulses at wrist
• Check X-ray finding
Discharge plan:
• Referral letter to Orthopaedic Clinic in 2 weeks with
XOA
X-ray on arrival
• Analgesics e.g. T Paracetamol 1 g QID + Cap Tramal 50 mg TDS
• Advise patient to be compliant to the collar and cuff & strapping
• Medical Certificate (MC)
Notes
💡 ED team should refer ortho team if failed to reduce dislocation after 1 – 2 attempts
Related Posts
• Posterior shoulder dislocation [open]
• Procedural sedation [open]
Anterior Shoulder Dislocation VS Posterior Shoulder Dislocation
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Q&A
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Further Reading
• FB Dr Alzamani