What is the role of traction-countertraction in 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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For traction-countertraction, while the patient lies supine, apply axial traction to the arm with a sheet wrapped around the forearm and the elbow bent at 90°. An assistant should apply countertraction using a sheet wrapped under the arm and across the chest while the shoulder is gently rotated internally and externally to disengage the humeral head from the glenoid. [6]

Scapular rotation is a less traumatic technique and has success rates of more than 90% in experienced hands, often without sedation. With the patient lying prone, apply manual traction or 5-15 lb of hanging weight to the wrist. After relaxation, rotate the inferior tip of the scapula medially and the superior aspect laterally. Alternatively, the patient can be seated while an assistant provides traction-countertraction by pulling on the wrist with one hand and bracing the upper chest with the other. The same scapular rotation is then performed. [6]

For reduction of a posterior dislocation, apply gentle, prolonged axial traction on the humerus. Then, add gentle anterior pressure while coaxing the humeral head over the glenoid rim. Slow external rotation may be needed.

For reduction of an inferior dislocation, maintain gentle axial traction on the humerus while gentle abduction is applied. Apply countertraction across the ipsilateral shoulder. Following reduction, slowly adduct the arm. Buttonholing of the humeral head through the capsule usually requires open reduction.

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