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  3. Assessment and management of shoulder dislocation
Practice Clinical Updates

Assessment and management of shoulder dislocation

BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4485 (Published 07 December 2020) Cite this as: BMJ 2020;371:m4485
  1. Lukas PE Verweij, PhD candidate1 2 3,
  2. David N Baden, emergency medicine doctor4,
  3. Julia MJ van der Zande, patient co-author5,
  4. Michel PJ van den Bekerom, orthopaedic surgeon, shoulder and elbow specialist5 6
  1. 1Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
  2. 2Academic Center for Evidence-based Sports medicine (ACES), Amsterdam UMC, Amsterdam, Netherlands
  3. 3Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, Netherlands
  4. 4Emergency Department, Diakonessenhuis, Utrecht, Netherlands
  5. 5Department of Orthopaedic Surgery, Shoulder and Elbow unit, OLVG, Amsterdam, Netherlands
  6. 6Department of Human Movement Sciences, Faculty of Behavioural and Movement sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
  1. Correspondence to LPE Verweij l.p.verweij{at}amsterdamumc.nl

What you need to know

  • A traumatic first time anterior shoulder dislocation shows a peak incidence in men aged 16-20 and in women aged 61-70

  • Refer patients with suspected dislocation to emergency services for reduction

  • Risk of experiencing recurrent dislocation is greater in patients age ≤40, in men, and in people with hyperlaxity

  • Immobilising the shoulder for one week is often recommended to reduce pain and prevent recurrence; however, the evidence for immobilisation duration is uncertain

  • Young, active patients and those who participate in sports are more likely to benefit from operative treatment in contrast to older patients (without associated injuries) or patients with a low activity level, where conservative therapy may be sufficient

Shoulder dislocations are painful and have an impact on activities of daily living and participation in sports. Most shoulder dislocations (>95%) occur in the anterior direction and are usually the result of trauma.123 Optimal management can prevent recurrent dislocations and reduce social costs.456 Patients with first time dislocations often receive insufficient information to make a decision about their management.7 Shared decision making must take into consideration the patient’s preferences for surgery or physical therapy, their expectations, and the likelihood of recurrence.6 In this clinical update we present an initial approach for primary care and emergency healthcare providers to assess and manage patients with a traumatic anterior shoulder dislocation.

Who experiences a shoulder dislocation?

More than 70% of shoulder dislocations occur in men.123 In a cohort study of 16 763 patients who experienced a first time anterior dislocation in the UK, peak incidence was in men aged 16-20 (80.5 per 100 000 person years) and in women aged 61-70 (28.6 per 100 000 person years).3 These peak incidences are similar in other Western countries, such as Canada, the US, and Norway.23

In young patients, shoulder dislocations …

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