A 22-year-old male presents with right shoulder pain while jumping on a trampoline. He denies numbness or weakness. Exam shows a normal neurovascular status. An X-ray is shown. What is the next best step in management?

• A. Scapular manipulation
• B. Immediate shoulder arthroscopy
• C. Sling immobilization with PT
• D. Open reduction and internal fixation

Answer: (A)

Acute anterior shoulder dislocation in a young, active patient is best managed with prompt closed reduction to realign the humeral head into the glenoid. Scapular manipulation is a reduction technique used in the emergency setting that applies controlled scapular movement and gentle traction to guide the humeral head back into place. It’s effective, can be done quickly with appropriate analgesia or sedation, and avoids invasive surgery when the joint is stable and there’s no neurovascular compromise.

After achieving reduction, obtain repeat imaging to confirm realignment and check for associated injuries, and reassess neurovascular status. Then immobilize the arm in a sling and start a physical therapy plan after a short period of immobilization to restore range of motion and strength. If reduction isn’t possible, if there’s fracture, or if a posterior dislocation or other complex injury is suspected, more advanced management would be required.