How is scapular manipulation performed for the reduction of shoulder dislocations?

Updated: Aug 17, 2018
  • Author: Anantha K Mallia, DO, FACEP; Chief Editor: Erik D Schraga, MD  more...
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Answer

With the patient prone or seated and the back exposed, the affected arm is placed in 90° of forward flexion at the shoulder, and slight traction is applied.

If the patient is prone, weights are used (as in the Stimson technique), or manual downward traction is applied by an assistant. If the patient is seated, an assistant should stand, facing the patient, and use one arm to firmly grasp the wrist of the dislocated arm. The assistant should then apply steady forward traction parallel to the floor while applying countertraction with the other arm, which is outstretched and resting on the patient’s clavicle (see the image below).

Reduction of shoulder dislocation: scapular manipu Reduction of shoulder dislocation: scapular manipulation. Sitting position.

The treating physician then stands lateral to the affected shoulder and stabilizes the scapula by placing the palm of one hand on the lateral aspect of the shoulder with the thumb securely on the superior lateral border, then placing the other palm over the inferior tip of the scapula and positioning the thumb on the inferior lateral border of the scapula (see the image below).

Reduction of shoulder dislocation: scapular manipu Reduction of shoulder dislocation: scapular manipulation. Hand placement.

The physician then uses both hands to rotate the inferior tip of the scapula medially and the superior aspect laterally with slight dorsal displacement. The goal is to move the glenoid fossa back into the correct anatomic position. [7, 39] To facilitate reduction, the assistant may apply, along with traction, slight external rotation of the humerus, elbow flexion in 90°, or both.


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