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Shoulder Reduction

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Other Names

  • Glenohumeral Reduction

Background

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

Indications


Contraindications


Anterior Dislocations

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[1]
    • 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

Equipment

Preparation

Anatomy

Technique


Posterior Dislocations

  • Needs to be updated
  • Consider Stimson technique

Inferior Dislocations


Aftercare


Complications


See Also


References

  1. Neil Cunningham, MBBS, FACEM. "Cunningham Technique". Shoulderdislocation.net.
Created by:
John Kiel on 11 February 2020 14:57:46
Authors:
Last edited:
6 April 2021 17:12:31
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