What are the red flags for shoulder & collarbone injury in urgent care?

Skin tenting over clavicle fracture → Ortho today; Numbness over the “regimental badge” area / weak deltoid → Axillary nerve injury — document before and after reduction; Absent radial pulse or neuro deficit → ED now; Shoulder pain with chest pain, breathlessness or sweating → Cardiac / PE — don’t call it musculoskeletal; Posterior dislocation (seizure, electric shock) → Easily missed — X-ray, ortho

What should I prescribe for shoulder & collarbone injury?

Paracetamol: 1 g every 4–6 hours, max 4 g in 24 h (reduce if under 50 kg or liver risk) (As needed); Ibuprofen: 400 mg three times a day with food (3–5 days. Avoid: NSAID-sensitive asthma, GI bleed/ulcer, renal impairment, anticoagulants, heart failure, pregnancy)

Shoulder Dislocation & Clavicle Fracture | Urgent Care Clinic

Q: What safety-netting advice should I give for shoulder & collarbone injury?

Advise the patient to return or seek help if: Arm or hand becomes numb, weak, cold or pale; Skin over the collarbone looks stretched, white or breaks; Shoulder pops out again.

1Rule out first — red flags

If you find…	…then
Skin tenting over clavicle fracture	Ortho today
Numbness over the “regimental badge” area / weak deltoid	Axillary nerve injury — document before and after reduction
Absent radial pulse or neuro deficit	ED now
Shoulder pain with chest pain, breathlessness or sweating	Cardiac / PE — don’t call it musculoskeletal
Posterior dislocation (seizure, electric shock)	Easily missed — X-ray, ortho

2Focused history

Mechanism: fall onto shoulder / outstretched arm / seizure
Previous dislocations
Hand dominance, job, sport
Numbness or weakness in the arm
PMH, anticoagulants

3Focused examination

Look: deformity, step at ACJ, squared-off shoulder, skin
Feel: clavicle, ACJ, humeral head
Range of movement as pain allows
Axillary nerve (regimental badge sensation), radial pulse, hand neurology

4Decide — investigate only if it changes the plan

Investigation	Only if…
Shoulder X-ray (AP + axillary or Y view)	Suspected dislocation (before and after reduction) or fracture
Clavicle X-ray	Clavicle tenderness or deformity

5Treat & send home

Management & advice

Mid-shaft clavicle fracture (not tenting) → broad arm sling for comfort, analgesia, early pendulum exercises
ACJ sprain/dislocation → sling for comfort, early movement
Dislocation → reduction in ED, then sling and fracture/shoulder clinic
Avoid lifting the arm above the shoulder until reviewed

Refer / follow-up

Fracture or dislocation → fracture clinic / virtual fracture clinic
First-time dislocation in a young person → shoulder clinic (instability)

℞

Discharge prescription (TTO)Typical adult doses — check the BNF/BNFc, allergies, renal function, pregnancy and interactions.

Drug	Dose	Duration / notes
Paracetamol	1 g every 4–6 hours, max 4 g in 24 h (reduce if under 50 kg or liver risk)	As needed
Ibuprofen	400 mg three times a day with food	3–5 days. Avoid: NSAID-sensitive asthma, GI bleed/ulcer, renal impairment, anticoagulants, heart failure, pregnancy

6Safety-net

Say it like this

You’ve broken the middle of your collarbone. These usually heal well in a sling. Use the sling for comfort and start gentle movements as the pain allows. The fracture clinic will follow you up. Come back if your hand goes numb or cold, or if the skin over the break looks stretched or white.

Come back / call 111 — or 999 if severe — if:

Arm or hand becomes numb, weak, cold or pale
Skin over the collarbone looks stretched, white or breaks
Shoulder pops out again

7Patient leaflets — scan & go

Official NHS pages. Ask the patient to scan the code with their phone camera, or tap “Show to patient” to make it full screen.

Broken collarbonenhs.uk/conditions/broken-collarbone

Dislocated shouldernhs.uk/conditions/dislocated-shoulder

8Document

Shoulder & collarbone injury — clinic note

A structure to document efficiently. It is not a completeness check — use your trust’s system and your clinical judgement.

URGENT CARE — SHOULDER & COLLARBONE INJURY PRESENTING COMPLAINT: HISTORY Mechanism: fall onto shoulder / outstretched arm / seizure: Previous dislocations: Hand dominance, job, sport: Numbness or weakness in the arm: PMH, anticoagulants: RED FLAGS (record present / absent) [ ] Skin tenting over clavicle fracture [ ] Numbness over the “regimental badge” area / weak deltoid [ ] Absent radial pulse or neuro deficit [ ] Shoulder pain with chest pain, breathlessness or sweating [ ] Posterior dislocation (seizure, electric shock) PMH: DRUG HISTORY: ALLERGIES: SOCIAL (job / who is at home / driving): OBSERVATIONS: RR SpO2 HR BP Temp (NEWS2 ) EXAMINATION Look: deformity, step at ACJ, squared-off shoulder, skin: Feel: clavicle, ACJ, humeral head: Range of movement as pain allows: Axillary nerve (regimental badge sensation), radial pulse, hand neurology: INVESTIGATIONS: none required / Shoulder X-ray (AP + axillary or Y view), Clavicle X-ray — result: IMPRESSION: PLAN Treatment / TTO (drug, dose, duration): Advice given: Leaflet given (QR / printed): Broken collarbone, Dislocated shoulder Follow-up / referral: SAFETY-NETTING (told to return / call 111 / 999 if): - Arm or hand becomes numb, weak, cold or pale - Skin over the collarbone looks stretched, white or breaks - Shoulder pops out again Patient understands and agrees with the plan: Y / N Seen by: Grade: Date/Time:

✓Guidelines

Doses are typical adult doses drawn from the guidance above. Always check the current BNF/BNFc and your local antimicrobial policy.

More injuries & musculoskeletal

Ankle & foot injuryTwisted ankle or foot — Ottawa rules decide the X-ray.Knee injuryTwisting or direct knee injury — Ottawa knee rule, spot the ACL and locked knee.Wrist injury & scaphoidFall on the outstretched hand — distal radius vs scaphoid.Hand & finger injuryBoxer’s fracture, mallet finger, crush injuries and the hand you must not miss.