Clinical Practice and Cases in Emergency Medicine

Introduction: Shoulder dislocations comprise approximately half of all major joint dislocations evaluated in the emergency department. Despite often being considered a simple injury, diagnosing a dislocation can be difficult, especially when accompanied by a fracture associated with unusual mechanism, or when the physical examination is limited. Missed and delayed diagnoses can result in poor patient outcomes and legal risks for clinicians, necessitating a high level of vigilance. 

Case Series: We review three medical malpractice cases centered on the failure to recognize shoulder dislocations. Key issues included missed diagnosis, limited physical examination documentation, and inadequate discharge instructions. 

Conclusion: Shoulder dislocations can be challenging to identify, and missed diagnoses give rise to subsequent clinical and legal risks. Emergency physicians must maintain a high index of suspicion for this injury, recognize the limitations of standard imaging, and thoroughly document clinical decision-making during both initial evaluation and patient discharge.