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First traumatic anterior shoulder dislocation — MSRA MCQ

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ModerateShoulder InjuriesFirst traumatic anterior shoulder dislocationMSRA

A 21-year-old semi-professional rugby player attends general practice 8 days after a first traumatic anterior dislocation of his dominant shoulder during a tackle. The shoulder was reduced in the emergency department. Pre- and post-reduction radiographs showed no fracture and concentric reduction. He has been using a sling intermittently and his pain is improving. He has no paraesthesia, recurrent deformity or sensation of instability at rest. Active abduction is 120 degrees, external rotation is mildly painful but strong, and passive range of movement is near full. Deltoid power and sensation over the lateral upper arm are normal, as are distal pulses and hand neurology. What is the most appropriate management now?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Refer early to orthopaedics while arranging structured shoulder rehabilitation

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

This patient has a reduced first traumatic anterior shoulder dislocation without evidence of acute rotator-cuff, axillary-nerve or vascular injury. However, he is young, athletic and participates in a contact sport, placing him in a higher-risk group for recurrent instability. UK NHS shoulder-instability guidance advises early orthopaedic escalation for young (under 27), athletic and/or manual patients after traumatic dislocation, alongside rehabilitation. Early referral enables discussion of recurrence risk and whether further investigation or stabilisation is appropriate; it does not mean immediate surgery is mandatory. A is inappropriate because MRI arthrography is not required in primary care before referral and is commonly directed by the specialist pathway. B is attractive because rehabilitation is essential after most reduced dislocations, but physiotherapy alone misses the indication for early orthopaedic assessment in this risk group. C risks avoidable stiffness; prolonged immobilisation is not routine where the shoulder is reduced and neurovascular status is normal. D would be reasonable for a lower-risk patient progressing through rehabilitation, but delayed reassessment is inappropriate for a young contact-sport athlete with a high redislocation risk.

Reference: Instability / dislocation (2024; accessed 15 August 2026) — https://www.rightdecisions.scot.nhs.uk/ggc-msk-index/shoulder/instability-dislocation/ Instability/Recurrent Dislocation (Current page; 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