How can I differentiate between a shoulder dislocation and other shoulder injuries during the initial assessment?

During the initial assessment, differentiating a shoulder dislocation from other shoulder injuries relies on a combination of clinical history, physical examination, and recognition of characteristic signs. A shoulder dislocation typically presents with a history of trauma followed by acute shoulder pain and an inability to move the joint normally. The affected arm is often held in a slightly abducted and externally rotated position, and there may be a visible deformity or asymmetry compared to the opposite shoulder. Palpation may reveal an empty glenoid fossa and a prominent humeral head displaced anteriorly or posteriorly depending on the dislocation type. Neurovascular assessment is crucial to identify any associated nerve or vessel injury. In contrast, other shoulder injuries such as fractures or soft tissue injuries may present with swelling, bruising, and pain but without the classic deformity or fixed limb position seen in dislocations. Imaging, typically an X-ray, is essential to confirm the diagnosis and exclude fractures or other pathologies before definitive management. This approach aligns with UK guidelines emphasizing careful clinical assessment and imaging to guide management NICE NG38, while the literature supports a multi-stage preventive management strategy starting with accurate initial diagnosis to reduce complications Habermeyer et al. 1998.