Shoulder Dislocation Goals of Treatment Traumatic dislocations of the shoulder usually result from an indirect force, which overcomes the supports provided by the muscles and ligaments The initial goal of treatment is to manage the pain and expedite reduction of the shoulder dislocation after radiographs have been obtained Postreduction radiographs should be obtained to confirm relocation and evaluate for fractures after reduction CLINICAL PEARLS AND PITFALLS Complications of shoulder dislocation include fracture of the humeral head (Hill–Sachs lesion), tearing of the anteroinferior glenoid labrum with or without associated bony injury (Bankart lesion), and neurovascular injuries (Fig 111.11 ) Due to its close association with the glenohumeral joint, the axillary nerve may be injured with shoulder dislocation, resulting in motor and sensory defects There is a high rate of recurrence or joint instability in young active patients 14 years and older Consequently, patients who plan to return to competitive contact sports may be candidates for surgical stabilization after a first-time instability event Recurrence rates are lower in patients with open relative to closed proximal humeral physis at the time of primary dislocation Current Evidence Anterior shoulder dislocation is the most common joint dislocation seen in the pediatric ED, and accounts for greater than 90% of shoulder dislocations Shoulder dislocation is rare in infants and children aged less than 10 years, but becomes increasingly common through adolescence following physeal closure In the skeletally immature child, fracture of the proximal humerus is more common than dislocation due to the anatomy of the physis Shoulder dislocations are associated with a 70% to 90% recurrence rate Intravenous sedation and analgesia has been the mainstay of pain control for shoulder reduction when indicated; however, adult literature supports the use of intra-articular injection of lidocaine as adjunctive or alternative approach to pain control Although no studies in strictly pediatric populations exist, consideration