skip to main content

Suspected vascular injury after spontaneously reduced traumatic shoulder dislocation — MSRA MCQ

Instant feedback + full explanation. One question, done properly.

HardShoulder InjuriesSuspected vascular injury after spontaneously reduced traumatic shoulder dislocationMSRA

A 68-year-old woman attends your GP surgery 90 minutes after falling down two steps onto her outstretched left arm. She describes immediate severe shoulder pain and a visible deformity that “went back in” when she moved her arm while being helped into a car. She now has increasing upper-arm swelling and aching pain. The shoulder contour currently appears normal. The left hand is pale and cool, capillary refill is 5 seconds, and the radial pulse is not palpable compared with a normal right radial pulse. She reports diffuse tingling in the hand but can flex and extend the fingers. There is no neck pain, chest pain or breathlessness. 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: E — Arrange emergency ambulance transfer to the emergency department for suspected vascular injury following shoulder dislocation

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

This is an emergency. The history strongly suggests a traumatic glenohumeral dislocation that has spontaneously reduced: transient visible deformity does not exclude important associated injury after the joint has relocated. Her progressively swollen upper arm, cool pale hand, markedly delayed capillary refill and absent radial pulse indicate threatened distal perfusion, with paraesthesia providing an additional neurovascular warning sign. Suspected vascular injury takes priority over confirming the precise shoulder lesion in primary care. She requires immediate emergency-department transfer by ambulance for urgent vascular and orthopaedic assessment; she should not be sent independently for outpatient imaging. B is initially attractive because radiographs are needed after a suspected dislocation, but imaging must not delay emergency assessment of limb ischaemia. C is inappropriate because ultrasound through a community MSK pathway is neither sufficiently urgent nor appropriate for suspected arterial injury. D risks avoidable delay in a potentially limb-threatening complication. E would be appropriate only after acute structural injury and neurovascular compromise had been excluded and an appropriate rehabilitation plan established.

Reference: NHS: Dislocated shoulder (2023) — https://www.nhs.uk/conditions/dislocated-shoulder/?src=conditionswidget NHS: Shoulder pain (22 May 2023) — https://www.nhs.uk/symptoms/shoulder-pain/