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We were touring Japan with a group of high school students when one of the girls slipped and fell dislocating her shoulder. We thought she would have to have surgery in a foreign country. But it turns out, the doctor used a Japanese technique for putting the shoulder back in place with only a small amount of discomfort, no drugs, and no surgery. How do we get the word out to our doctors about this marvelous method?

You may not have to because a group of orthopedic surgeons from the Gifu University School of Medicine in Gifu, Japan recently published an article describing a very similar technique. They included a careful and clear description of the reduction technique along with photos of the procedure. Basically, the patient sits in a chair facing the surgeon. The surgeon takes hold of the patient's forearm very gently and raises the arm straight forward 90 degrees. The surgeon places his other hand on the patient's chest wall against the front of the patient's shoulder. The surgeon's thumb was against the head of the humerus (upper arm bone). Just by pulling on the patient's arm with one hand while applying pressure on the humeral head with the other hand, the humeral head slipped back into the socket. If the patient tensed up, the surgeon just lowered the arm a little, waited for the pain to go away and the muscles to relax and started the procedure again. The hand against the shoulder helped control the tilt of the shoulder socket. The technique is done slowly and gently. If the surgeon isn't able to successfully reduce the shoulder after several tries, the patient can be placed supine (lying on his or her back). A forward elevation maneuver can be used instead. The dislocated arm is placed overhead while the surgeon applies traction, gently rotating the arm outward until the head of the humerus slips back into the socket. The key to this technique is to work with patients who are already seated and self-supporting their arm. Changing positions causes the shoulder to tense up and can be avoided with this method. This method can be tried first before using drugs, mechanical force, or surgery. There was an 80 per cent success rate but no clear reason why the other 20 per cent could not be reduced with this method. The success rate wasn't quite as high as with some other methods, but the fact that no narcotics or surgery were needed is the added benefit.

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