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New Technique for Reducing Anterior Shoulder Dislocation

Falls from skiing accidents, snowboarding injuries, car accidents and other traumatic events account for many first-time shoulder dislocations. When the shoulder doesn't pop back in place on its own, the patient ends up in the emergency department or doctor's office for a reduction (put it back in the socket). There are many ways to reduce the shoulder but most require anesthesia to put the patient asleep and relax the muscles or strong narcotic medications for pain.

In this report, surgeons from Japan propose a new method for reducing anterior (forward) shoulder dislocations. Most shoulder dislocations are anterior so this approach will be useful in many cases. No medication or anesthesia was used. The patient remained in the sitting position. There were no complications from the technique such as fractures or nerve injury.

The sitting position used was more comfortable for patients who were already holding the dislocated arm with the other hand. The patient was sitting in a chair facing the surgeon. The surgeon took hold of the patient's forearm very gently and raised the arm straight forward 90 degrees. The surgeon placed 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 wasn't able to successfully reduce the shoulder after several tries, the patient was placed supine (lying on his or her back). A forward elevation maneuver was used instead. The dislocated arm was placed overhead while the surgeon applied traction, gently rotating the arm outward until the head of the humerus slipped back into the socket.

Afterwards, everyone was given a sling to wear to support the arm during the acute phase of healing. X-rays were taken to confirm reduction. Results of this technique were evaluated by reviewing the charts of patients later. Data collected included previous history of shoulder dislocation, use of medications for reduction, type of reduction technique used, and before and after X-rays.

A total of 34 patients were treated for anterior shoulder dislocation with this new reduction method. The surgeon accomplished the task alone while talking with the patient. Combining the sitting position with a traction technique is new and has never been described before in medical journals. Compared with other methods of shoulder reduction, this was simple, unique, drug-free, and successful. It worked for almost 80 per cent of the patients.

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 no clear reason why a small number of patients 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 were needed was the added benefit.

References: Kazu Matsumoto, MD, PhD, et al. Anterior Dislocation of the Shoulder: A Simple and Sitting Method for Reduction. In Current Orthopaedic Practice. May/June 2009. Vol. 20. No. 3. Pp. 281-284.

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