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Shoulder Reduction

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Other Names

  • Glenohumeral Reduction
  • Shoulder Reduction

Background

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

Indications


Contraindications


Anterior Dislocations

Milch Maneuver[1]
Davos Technique[2]
Stimson Maneuver[1]
Cunningham Technique[3]

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[4]
    • 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. 1.0 1.1 Image courtesy of coreEM.org, "Shoulder Dislocation"
  2. Image courtesy of resus.com.au, "The Davos Technique for Shoulder relocation"
  3. Alkaduhimi, H., et al. "A systematic and technical guide on how to reduce a shoulder dislocation." Turkish Journal of Emergency Medicine 16.4 (2016): 155-168.
  4. Neil Cunningham, MBBS, FACEM. "Cunningham Technique". Shoulderdislocation.net.
Created by:
John Kiel on 11 February 2020 14:57:46
Authors:
Last edited:
26 January 2023 09:29:41
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