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First-time traumatic anterior shoulder dislocation with high recurrence risk — MSRA MCQ

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HardShoulder InjuriesFirst-time traumatic anterior shoulder dislocation with high recurrence riskMSRA

A 23-year-old right-handed semi-professional rugby player is reviewed in general practice 6 days after a first traumatic anterior dislocation of her dominant shoulder during a tackle. The joint was reduced in the emergency department. Pre- and post-reduction anteroposterior and axial radiographs showed no fracture and a concentrically reduced glenohumeral joint. She has used a sling for comfort and has no pain at rest. She reports marked apprehension when attempting to reach overhead or externally rotate the abducted arm, as she feels the shoulder may "come out again". Active and passive ranges are near full but abduction-external rotation reproduces apprehension, relieved by relocation testing. Rotator-cuff strength, deltoid contraction, sensation over the lateral upper arm, distal power, pulses and capillary refill are normal. She has no recurrent deformity, paraesthesia, fever or neck pain. What is the most appropriate management now?

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Correct answer: C — Refer early to orthopaedics in parallel with a structured shoulder-stabilisation rehabilitation programme

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

This is a reduced first traumatic anterior shoulder dislocation without fracture, neurovascular compromise, rotator-cuff deficit or evidence of persistent dislocation; therefore, same-day emergency reassessment is not indicated. However, she is 23 years old, participates in collision sport and has clinically demonstrable instability/apprehension. These features place her at high risk of recurrent instability. UK NHS shoulder-instability guidance advises early orthopaedic referral, alongside rehabilitation, for traumatic primary dislocators aged under 27 who are athletic and/or manual workers. A is inappropriate because prolonged immobilisation is not the preferred strategy; a sling may be used briefly for comfort, but rehabilitation should begin to restore movement, rotator-cuff control and dynamic stability. C is plausible for lower-risk patients, but delays specialist assessment in a young collision-sport athlete with a high recurrence risk. D would be appropriate for an unreduced dislocation, fracture concern, or evolving neurovascular deficit, none of which is present. E is not the next step: specialist assessment can determine whether advanced imaging is needed, and imaging should not delay early referral in this high-risk presentation.

Reference: Instability / dislocation (Published approximately 2024; accessed 16 August 2026) — https://www.rightdecisions.scot.nhs.uk/ggc-msk-index/shoulder/instability-dislocation/ Instability / dislocation (Published approximately 2024; accessed 16 August 2026) — https://www.rightdecisions.scot.nhs.uk/ggc-msk-index/shoulder/instability-dislocation/