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Traumatic anterior shoulder dislocation with high risk of recurrent instability — MSRA MCQ

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HardShoulder InjuriesTraumatic anterior shoulder dislocation with high risk of recurrent instabilityMSRA

A 23-year-old semi-professional rugby player is reviewed 10 days after a first traumatic anterior dislocation of his dominant shoulder during a tackle. The joint was reduced in the emergency department and post-reduction radiographs confirmed concentric reduction. The radiology report notes a small Hill-Sachs lesion but no glenoid fracture. He has normal radial pulse and sensation over the lateral deltoid and hand. His pain is settling and he has started gentle range-of-movement exercises, but reports marked apprehension when reaching overhead or externally rotating the abducted arm. He works as a scaffolder and wishes to return to contact sport. What is the most appropriate next management step?

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Correct answer: C — Refer early to orthopaedics in parallel with structured shoulder rehabilitation

Explanation lettering: C = shown as A · A = shown as B · D = shown as C · E = shown as D · B = shown as E

This is a reduced first traumatic anterior dislocation, so same-day emergency reduction is not indicated. However, he has several features associated with a high risk of recurrent instability and a lower threshold for early specialist assessment: he is young, participates in collision sport, performs heavy overhead manual work, and has a Hill-Sachs lesion on radiography. Early orthopaedic referral should occur alongside—not instead of—rehabilitation directed at restoring range of movement, rotator-cuff control, scapular stability and proprioception. This permits timely discussion of stabilisation options if clinically appropriate. A is attractive because rehabilitation is central to management after dislocation, but delaying escalation until prolonged rehabilitation has failed is inappropriate in this high-risk traumatic presentation. B is plausible because labral injury may coexist, but MRI arthrography is not required in primary care before referral; specialist pathways can determine the appropriate imaging. C is incorrect because prolonged immobilisation is not supported as routine management and risks stiffness; a sling may be used briefly for comfort. E would be appropriate for an unreduced dislocation or neurovascular compromise, neither of which is present.

Reference: Instability / dislocation — NHS Greater Glasgow and Clyde MSK Index (Accessed 15 August 2026) — https://www.rightdecisions.scot.nhs.uk/ggc-msk-index/shoulder/instability-dislocation/ Instability/Recurrent Dislocation — NHS Tayside RefGuide (Next review date 4 July 2027) — https://www.rightdecisions.scot.nhs.uk/nhs-tayside-refguide/surgery-and-orthopaedics/orthopaedic-and-trauma-surgery/shoulder-and-elbow/instabilityrecurrent-dislocation/?organization=nhs-tayside