Shoulder Dislocation . Reduction Techniques
Early treatment of shoulder dislocation promptly eliminates the stretch and compression of nerves and muscle, and reduces the amount of muscle spasm which must be overcome to reduce the shoulder. Although some dislocations can be reduced without medication, in many instances, the patient is lightly anaesthetised or given a muscle relaxant. The depth of anaesthesia depends on the amount of trauma which produced the dislocation, the duration of the dislocation, how many times the patient has previously dislocated, whether the dislocation is locked, and to what extent the patient can voluntarily relax his shoulder muscles. Some of the main reduction techniques are described below.
Hippocrates Technique:
When only one person is available to reduce the shoulder, the stockinged foot of the physician is used as countertraction. The heel does not go into the armpit but extends against the chest wall. The traction is slow and gentle. The arm may be gently rotated internally and externally to disengage the head of the humerus. Hippocrates also described other techniques such as the one pictured here where a child provides countertraction. (Fig. 3a)
Stimson's Technique:
Appropriate weights (e.g., 5 pounds) are taped to the wrist of the dislocated shoulder which hangs free over the edge of the table. If medication is used the patient should be monitored as it may take 15 or 20 minutes for the reduction to occur.
Milch's Technique:
With the patient lying on the back, the arm is raised by the side and externally rotated. The therapist's thumb is used to gently push the head of the humerus back in place. A modified version of this technique is applied to patients lying on their abdomen.
Milch:
Early treatment of shoulder dislocation promptly eliminates the stretch and compression of nerves and muscle, and reduces the amount of muscle spasm which must be overcome to reduce the shoulder. Although some dislocations can be reduced without medication, in many instances, the patient is lightly anaesthetised or given a muscle relaxant. The depth of anaesthesia depends on the amount of trauma which produced the dislocation, the duration of the dislocation, how many times the patient has previously dislocated, whether the dislocation is locked, and to what extent the patient can voluntarily relax his shoulder muscles. Some of the main reduction techniques are described below.
Hippocrates Technique:
When only one person is available to reduce the shoulder, the stockinged foot of the physician is used as countertraction. The heel does not go into the armpit but extends against the chest wall. The traction is slow and gentle. The arm may be gently rotated internally and externally to disengage the head of the humerus. Hippocrates also described other techniques such as the one pictured here where a child provides countertraction. (Fig. 3a)Stimson's Technique:
Appropriate weights (e.g., 5 pounds) are taped to the wrist of the dislocated shoulder which hangs free over the edge of the table. If medication is used the patient should be monitored as it may take 15 or 20 minutes for the reduction to occur.
Milch's Technique:
With the patient lying on the back, the arm is raised by the side and externally rotated. The therapist's thumb is used to gently push the head of the humerus back in place. A modified version of this technique is applied to patients lying on their abdomen.
Milch:
closed reduction of anterior shoulder dislocation by traction on the arm, which is abducted overhead with the patient in the supine position, external rotation, and pressure on the head of the humerus; in some modifications of this technique the patient lies prone.
Resume Milch´s Technique:
Lying on the back - traction on the arm - abduction and external rotation overhead - pressure on the head of humerus with the doctor´s thumb
Kocher's Leverage Technique:
This technique was first described in Egyptian hieroglyphs 3000 years ago (Fig. 3b). For this manoeuvre, the humeral head is levered on the anterior surface of the shoulder cavity and the long shaft of the humerus is levered against the chest wall until the reduction is complete. This procedure is prone to complications.
Matsen's preferred method of anterior reduction is shown in Fig. 3c. Here, the patient lies on the back with a sheet around the chest and also around the assistant's waist for countertraction. The surgeon stands on the side of the dislocated shoulder near the patient's waist with the elbow of the dislocated shoulder bent to 90 degrees. A second sheet, tied loosely around the surgeon's waist and looped over the patient's forearm, provides traction while the surgeon leans back against the sheet while grasping the forearm. Steady traction along the axis of the arm usually causes reduction [3].
Additional simple techniques for reducing the dislocated shoulder include: the forward elevation manoeuvre, the modified gravity method, the scapular manipulation, the crutch and chair technique, the chair and pillow technique, the external rotation method, and others.
Kocher's Leverage Technique:
This technique was first described in Egyptian hieroglyphs 3000 years ago (Fig. 3b). For this manoeuvre, the humeral head is levered on the anterior surface of the shoulder cavity and the long shaft of the humerus is levered against the chest wall until the reduction is complete. This procedure is prone to complications.
Matsen's preferred method of anterior reduction is shown in Fig. 3c. Here, the patient lies on the back with a sheet around the chest and also around the assistant's waist for countertraction. The surgeon stands on the side of the dislocated shoulder near the patient's waist with the elbow of the dislocated shoulder bent to 90 degrees. A second sheet, tied loosely around the surgeon's waist and looped over the patient's forearm, provides traction while the surgeon leans back against the sheet while grasping the forearm. Steady traction along the axis of the arm usually causes reduction [3].
Additional simple techniques for reducing the dislocated shoulder include: the forward elevation manoeuvre, the modified gravity method, the scapular manipulation, the crutch and chair technique, the chair and pillow technique, the external rotation method, and others.
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