What is reduction performed for the treatment of shoulder dislocation?

Updated: Nov 29, 2018
  • Author: Sharon R Wilson, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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The key to a successful reduction is slow and steady application of a maneuver with adequate analgesia and relaxation. Procedural sedation and analgesia (PSA) protocols in the ED assist in relaxing the musculature of the shoulder and make reduction a more comfortable and easier procedure. (For further information, see Procedural Sedation.)

Other adjuncts to facilitate reduction for patients who are high risk or may not be candidates for PSA include intra-articular lidocaine and ultrasound-guided interscalene (lidocaine) block of the brachial plexus.

Successful reduction is evidenced by marked reduction in pain and increased range of motion. A palpable or audible relocation ("clunk") may also be noted. The patient may be asked to touch the uninjured shoulder to safely demonstrate a successful reduction.

Some authors recommend an orthopedic consultation prior to reduction of posterior and inferior dislocations.

After the completion of all reductions, apply a shoulder immobilizer with a sling and swathe. A careful neurovascular examination must be performed prereduction and postreduction. Post-reduction radiography is still recommended, especially if the procedure was difficult.

Inappropriate traction and poor technique can result in complications with otherwise safe methods of reduction. The Kocher method has been discouraged because of the increased incidence of complications. [6] When performed correctly, it does not involve traction and has been demonstrated to be a safe technique. (For further information, see Joint Reduction, Shoulder Dislocation, Anterior.) In Kocher's original method, bend the arm at the elbow, press it against the body, rotate outwards until resistance is felt. Lift the externally rotated upper part of the arm in the sagittal plane as far as possible forwards and finally turn inwards slowly.

The Stimson technique requires that the patient lie prone on the bed with the dislocated arm hanging over the side. Traction is provided by up to 5-15 kg of weight attached to the wrist or above the elbow. Apply gentle internal/external humeral rotation. Reduction may take 20-30 minutes. [6]

In the external rotation method, while the patient lies supine, adduct the arm and flex it to 90° at the elbow. Slowly rotate the arm externally, pausing for pain. Reduce the shoulder before reaching the coronal plane. Often successful, this procedure requires only one physician and little force. Reduction usually occurs with the arm externally rotated between 70 and 110 degrees. [6]

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