Shoulder Reduction

Other Names

• Glenohumeral Reduction
• Shoulder Reduction

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Background

• This page describes techniques for reducing shoulder (glenohumeral) dislocations

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Indications

• See: Glenohumeral Dislocation

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Contraindications

• Chronic dislocation
  • Duration >24 hours should consult orthopedic surgery to consider performing procedure in operating room
  • Duration >2-3 weeks requires Total Shoulder Arthroplasty due to cuff atrophy
• Concomitant fractures
  • Proximal Humerus Fracture
  • Humeral Shaft Fracture
• Relative contraindication
  • Greater tuberosity fracture (can attempt reduction)

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Anterior Dislocations

Milch Maneuver

Davos Technique

Stimson Maneuver

Cunningham Technique

Leverage Techniques

• Kocher's
  • Place patient supine seated on exam table
  • Adduct affected arm and flex 90 degrees at the elbow
  • Externally rotate the shoulder (70-85 degrees) until resistance is felt
  • Lift arm anteriorly as far as possible
  • Internally rotate shoulder, moving hand towards contralateral shoulder
  • Humeral head should slip back into place
  • Note that a modified Kocher technique avoids abduction and internal rotation and reduces the dislocated shoulder through external rotation alone
• Milch
  • Place patient supine on exam table[10]
  • Grasp the wrist of the affected arm
  • Slowly abduct and externally rotate the arm until it is in the overhead position
  • Using your free hand, manipulate the humeral head laterally and superiorly to achieve reduction
• External Rotation
• FARES (FAst, REliable, Safe)
  • Place the patient supine or prone
  • Grasp the affected arm at the wrist
  • Gently oscillate the arm anteriorly and posteriorly (up and down as the patient is supine)
  • Apply gentle traction to the arm and slowly abduct
  • Once abducted to 90 degrees, externally rotate
  • Continue with ongoing traction and oscillation until reduction is achieved (generally with 120 degrees of abduction)
• Davos
  • Place the patient in a seated position on an examination table
  • Instruct the patient to flex the knee ipsilateral to the affected shoulder
  • Ask the patient to hold the wrist of the affected arm in the hand of the unaffected arm with both looped around the fully flexed knee
  • Tie the affected and unaffected wrists together around the fully flexed knee
  • Sit on the patient's foot to stabilize
  • Keeping the elbows adducted, ask the patient to slowly lean head back and allow shoulder to roll forward
  • Neck extension creates traction on the injured shoulder, which allows it to reduce
  • Note: Can be performed on self

Traction Techniques

• Matsen's Traction-Countertraction
  • Place patient in a supine position with a sheet wrapped around the torso and under the axilla of the affected arm
  • While an assistant provides countertraction by pulling on the sheet, apply longitudinal traction to the affected arm, manipulating the shoulder into reduction
• Stimson
  • Place patient prone on edge of table (affected shoulder closest to table edge)
  • Note that this is not an ideal technique as it requires a sedated patient to lay face-down, potentially leading to suffocation on the exam table
  • Allow hand to drop off table perpendicular to body
  • Attach 5 kg weight to arm
  • Maintain position for 20 - 30 minutes as needed
  • Provide additional scapular manipulation or gentle external and internal rotation to promote reduction
• Hippocratic
• Spaso
• Snowbird
  • Place patient in an upright sitting position
  • Adduct the affected arm and flex the elbow to 90 degrees
  • Create a loop of stockinette
  • Hang the loop of stockinette over the flexed elbow
  • Position an assistant behind the patient with arms under the axillae to provide countertraction
  • Using your hands to maintain flexion of the elbow, place your foot in the loop of stockinette and apply downward pressure to create traction on the elbow
• Eskimo
• Manes
• Cunningham
  • Stand in front of the seated patient
  • Hold the patient's affected arm adducted with the elbow flexed to 90 degrees
  • Massage trapezius, deltoid and bicipital muscles
  • Instruct the patient to move the shoulder superiorly and posteriorly to facilitate humeral head reduction (bring shoulder back and chest out)

Other

• Scapular Manipulation
  • Position yourself behind the patient
  • Stabilize the superior aspect of the shoulders with your fingers
  • Placing your hands on the patient's back, push the inferior tip of the scapular medially and dorsally with your thumbs

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Posterior Dislocations

• Needs to be updated
• Consider Stimson technique

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Aftercare

• Confirm reduction
  • Post reduction Standard Radiographs Shoulder
  • Can confirm with ultrasound as well
• Place in Shoulder Immobilizer
• Follow up in clinic in 1-2 weeks

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Complications

• Inability to reduce
• Chronic Shoulder Instability
• Fracture
• Vascular injury

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See Also

• Procedures (Main)
• Subluxations and Dislocations (Main)
• Shoulder Anatomy (Main)
• Shoulder Pain (Main)
• Physical Exam Shoulder

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