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Shoulder Dislocation Reduction Techniques

 

If reduction is attempted immediate no analgesia is necessary as the pec major has not gone into spasm yet. Only a single attempt in indicated without an xray. If reduction is delayed analgesia can be provided with 20mL of 1% lidocaine injected directly into the sulcus created by the absent humeral head, or conscious sedation (narcotics/morphine +/- benzodiazepine/versed).

Neurovascular exam must be repeated and documented after reduction.

 Analgesia Free Reduction Technique

  • Postion: supine with affected arm at the sided and elbow extended.
  • Maneuver: Gentle longitudinal traction accompanied by continuous abduction is applied. Continuous vertical oscillation of the upper arm is applied simultaneously as the arm is brought gently into abduction. After 90 degrees of abduction the arm is externally rotated and abduction continued gently to about 120 degres where reduction of the shoulder is expected.
  • 82% effective.
  • (Sayegh F, JBJS, 2006:88-B, SUPP I, 142)
  • (Eachempati KK, JBJS 2004;86Am:2431)

Rockwood Traction/Countertraction Technique

  • Position: supine with sheet wrapped in axilla, around the torso.
  • Maneuver: Traction is applied to arm while assistant pulls countertraction using the sheet. Slight internal and external rotation is applied. Reduction is generally felt with a loud "clunk."

 Milch Technique

  • Position: supine with arm forward and elevated 90°
  • Maneuver: arm is abducted with slight traction while the humeral head is pushed back into place with the thumb.
  • O'Connor DR, Orthopedics 2006;29:528

Scapular Manipulation Technique

  • Position: prone with shoulder slightly flexed and 5-15 lbs. of traction on the elbow
  • Maneuver: scapula is rotated by pushing medially on the inferior tip and rotating the superior aspect outward.

Stimson Prone Technique

  • Position: prone with involved shoulder hanging over the edge of the table. Apply 5-15lbs. of traction to the arm.
  • Maneuver: allow weight to slowly pull shoulder back into postion, may take 15 minutes for reduction.
 

Snowbird Technique (Westin)

  • Position: sitting on edge of bed with loop of stockinette around the proximal forearm with elbow flexed 90°. A sheet wrapped in the axilla around the torso for counter traction is often helpful.
  • Maneuver: downward pressure is applied with the foot along with gentle rotation of arm.
 

Hippocratic Method

  • Not recommended; associated with neurovascular injury, and proximal humerus fracture
 

Scapular Manipulation Technique

  • Patient placed prone with 5-15 lbs of traction applied to the arm.
  • Inferior angle of scapula is raised and rotated medially and the superior aspced is rotated laterally reducing the humeral head.
   

 

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