40

Shoulder dislocation is a common reason for emergency department visits, occurring primarily in young men but also in older women. Antero-inferior dislocation is the most frequent type, often resulting from an indirect trauma to an abducted, externally rotated, and extended arm. Recurrence is common, with risk factors including age, male sex, and the presence of associated injuries. The diagnosis is primarily clinical, and based on the Fresno-Quebec clinical decision rule, it may be possible to forgo routine pre-reduction plain films in order to rule out associated fractures. However, post-reduction imaging remains necessary. The performance of point-of-care ultrasound to confirm the diagnosis and proper reduction of the shoulder is excellent. Several reduction techniques exist, but none have proven superior. A major risk factor for reduction failure is delayed treatment. Some techniques may offer the advantage of avoiding procedural sedation. Intra-articular anesthesia seems to be an effective and safe alternative, particularly when procedural sedation is contraindicated. After reduction, it is recommended to immobilize the shoulder for 2 to 4 weeks in young patients and for 1 to 2 weeks in older patients to prevent the development of joint stiffness. Finally, patients should routinely be referred to orthopedic surgery, especially those with complications or high recurrence risk.