How is the two-step reduction 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

In 2006, Nho et al described a two-step method for the reduction of inferior shoulder dislocation (ie, luxatio erecta humeri). [50] In this technique, the inferior dislocation is converted to an anterior dislocation (step 1), which is subsequently reduced (step 2).

The patient is placed supine on a sturdy immobile surface (eg, a wheel-locked gurney). The clinician, standing on the affected side near the patient’s head, places one hand (the hand nearer the patient) on the lateral aspect of the midhumerus and places the other hand on the medial condyle.

Step 1 of the reduction may be divided into two parts. In part 1, the clinician pushes anteriorly with the hand on the midhumerus and pulls posteriorly with the hand on the medial condyle (see the first image below). This motion brings the humeral head to a position anterior to the glenoid (ie, the humeral head is now anteriorly rather than inferiorly dislocated). In part 2, the clinician adducts the arm and moves the hand on the medial condyle to grasp the wrist (see the second image below).

Reduction of shoulder dislocation: two-step reduct Reduction of shoulder dislocation: two-step reduction. Step 1, part 1. Push anteroinferiorly on midhumerus with hand A while pulling posteriorly on medial condyle with hand B.
Reduction of shoulder dislocation: two-step reduct Reduction of shoulder dislocation: two-step reduction. Step 1, part 2. After conversion of inferior dislocation to anterior dislocation, adduct arm and grasp patient's wrist.

In step 2 of the two-step reduction, the clinician, while holding the arm in adduction against the chest wall, externally rotates the shoulder by pulling on the wrist (see the image below).

Reduction of shoulder dislocation: two-step reduct Reduction of shoulder dislocation: two-step reduction. Step 2. Hand A holds patient's arm in adduction while hand B externally rotates arm to reduce now anteriorly dislocated humeral head.

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