How is the traction-countertraction technique performed for the reduction of shoulder dislocation?

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

The patient is supine on a securely locked stretcher, with the bed elevated to the height of the operator’s ischial tuberosities; this positioning is critical for ensuring smooth application of force. One sheet or strap is placed over the patient’s upper chest, under the axilla of the affected shoulder and underneath the back, so that the two ends of the sheet are of equal length and open to the unaffected side.

Standing on the unaffected side, the assistant takes a firm hold of each end of the sheet with each hand or securely ties the sheet around his or her own waist at the level of the ischial tuberosities. When instructed to start, the assistant leans back to provide countertraction with body weight. [9]

While maintaining the affected arm in 90° of flexion at the elbow, with both hands around the forearm, the physician applies traction by leaning backward with fully extended arms. It is important to use body weight, not upper arm muscles (eg, biceps), to provide traction along the axis of dislocation while the assistant applies countertraction.

Alternatively, to facilitate traction and reduce fatigue, the clinician can wrap another sheet around his or her proximal forearm and tie it around the back, letting the continuous loop sit at the level of the ischial tuberosities (see the images below). The affected extremity is flexed at the elbow and is placed inside the loop. With the elbow maintained in flexion, the clinician steps back to make the sheet taut and then leans back—again, using body weight to apply traction. The operator’s hands thus are free to guide and stabilize the extremity. [9]

Reduction of shoulder dislocation: traction and co Reduction of shoulder dislocation: traction and countertraction.
Reduction of shoulder dislocation: traction and co Reduction of shoulder dislocation: traction and countertraction.

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