Reduction of Shoulder

Dislocation Technique
Updated: Aug 09, 2017
Author: Anantha K Mallia, DO, FACEP; Chief Editor: Erik D Schraga, MD more...

TECHNIQUE

Approach Considerations
Reduction techniques can vary in terms of required force, time, equipment, and staff. [7] No
single reduction method is successful in every instance; therefore, the clinician should be
familiar with several reduction techniques.

Techniques commonly used to reduce anterior shoulder dislocations include the following [34,
35, 36, 37, 38]
:

Stimson maneuver
Scapular manipulation
External rotation
Milch technique
Spaso technique
Traction-countertraction

Posterior shoulder dislocations are typically reduced by means of traction-countertraction.

Techniques commonly used to reduce inferior shoulder dislocations include the following:

Axial (inline) traction

Two-step reduction

Adequate pain control and muscle relaxation, in conjunction with smooth atraumatic
technique, are the keys to a successful reduction. Slow, consistent movements by the
operator prevent pain and associated muscle spasm; quick pulling or release of tension is
sure to cause resistance and pain. Most techniques are facilitated by the following two
maneuvers:

Flexion of the elbow 90 to relax the biceps tendon

External rotation of the humerus, which releases the superior glenohumeral ligament
and presents the favorable side of the humeral head to the glenoid fossa

Signs of a successful reduction include the following:

Palpable or audible clunk

 Return of rounded shoulder contour
Relief of pain
Increase in range of motion (eg, the patient can touch the opposite shoulder with the
palm of the affected arm)

Before any attempts at reduction, it is essential to explain the procedure, benefits, risks, and
complications to the patient or the patients representative and to obtain informed consent.

Most neurovascular injuries are caused by the dislocation itself, but they can be induced or
exacerbated by attempted reduction. A conscientious neurovascular examination, both
before and after reduction, is important for documenting the presence and alteration of these
injuries.

For complex dislocations and failed initial attempts, orthopedic consultation in the
emergency department is recommended.