August 29, 2005

How to reduce a shoulder dislocation

http://www.physsportsmed.com/issues/2000/11_00/joy.htm

This is a link to a site that explains the technique I used to reduce my own shoulder dislocation which occured while I was kayaking in Little River Canyon. I provide it in case anyone wants to learn this technique themselves. I do not recommend this technique to anyone nor am I responsible if anyone chooses to learn and use it. I can only say that it was highly effective in my own circumstance, and it is what I would do again.

NOTE: this link no longer works but I found the text of the link in an online paddlers' newsletter. Here is the text:

Self-Reduction of Anterior Shoulder Dislocation
By Elizabeth A. Joy, MD
Found on the web at http://www.physsportsmed.com/issues/2000/11_00/joy.htm

Anterior dislocations of the shoulder are relatively
common, and many techniques in the literature
report achieving safe and satisfactory reductions.
One such technique is called the Boss-Holzach-
Matter method (1,2)-- referred to in this article as
the self-reduction technique. With physician
guidance, this technique safely allows patients to
assist and control relocation of the shoulder. It is
atraumatic, simple, and quick; can be used by
medical and nonmedical personnel; is possible
without analgesics or general anesthesia; and can be
done in any setting, including a medical facility. It is
ideal for use outdoors or in the backcountry
where transport to a medical facility would be
time-consuming and difficult.
The self-reduction technique has been prospectively
studied and found to lead to a successful anatomic
reduction in at least 60% of cases (1-3). It has been
reported successful and safe even when a displaced
fracture of the greater tuberosity or depression
fracture of the humeral head is present.
This technique may be employed once anterior
dislocation of the shoulder is detected. In the patient
with a frank anterior dislocation, several physical
examination findings can be apparent. The
dislocated humeral head may be observed as a bulge
anteriorly and should be palpable as well. The
deltoid muscle often appears and feels flattened, and
the patient often holds the involved arm slightly
abducted and externally rotated. Range-of-motion
testing will generally show restrictions in all planes
because of pain. Patients with an anterior
dislocation are unable to place the hand of the
affected side on the opposite shoulder (positive
Dugas test).
Although neurovascular injury is rare in an anterior
shoulder dislocation, examination of sensory, motor,
and vascular status is essential. Evidence of
vascular injury constitutes a medical emergency (4).
As with many other methods of relocation, reduction
will be most successful when done as soon as
possible after injury. This should limit muscle
spasm. It is important for physicians to understand
that muscle relaxation is absolutely essential to
successful shoulder reduction. Helping the patient
to voluntarily relax the muscles about the shoulder
will facilitate reduction.
To perform the self-reduction technique, the patient
sits on the ground with the ipsilateral knee bent 90°
and hands clasped around the knee and leans
backward to reduce the injury. Although the
literature is silent on the number of attempted
reductions, it is probably reasonable to attempt this
method up to three times, especially if the patient is
having difficulty relaxing or following instructions.
After reduction, the arm is placed in a sling for
comfort.
Patients and sometimes physicians have the idea
that a violent maneuver is required to reduce a
dislocated shoulder, but in fact the opposite is true.
The shoulder wants to be in alignment. After
overcoming some muscle spasm, it will usually
spontaneously reduce as this maneuver allows.
Counter to what might seem intuitive, pulling the
anteriorly dislocated shoulder farther anterior
actually permits disengagement of the Hill-Sachs
lesion, which can lock on the anterior glenoid.
Spontaneous reduction follows.
Finally, one should consider postreduction
evaluation in either a physician's office or emergency
department. This is especially important if it is the
patient's first dislocation.
References
1. Boss A, Holzach P, Matter P: Analgesic-free self-
reduction of acute shoulder dislocation [in German].
Z Unfallchir Versicherungsmed 1993;suppl 1:215-
220
2. Boss A, Holzach P, Matter P: A new self-
repositioning technique for fresh, anterior-lower
shoulder dislocation [in German]. Helv Chir Acta
1993:60(1-2):263-265
3. Ceroni D, Sadri H, Leuenberger A: Anteroinferior
shoulder dislocation: an auto-reduction method
without analgesia. J Orthop Trauma
1997;11(6):399-404
4. Feinberg E: Glenohumeral instability, in Souza E
(ed): Sports Injuries of the Shoulder: Conservative
Management. New York City, Churchill Livingstone,
1994, pp 344-345
Dr Joy is an associate professor in the department of
family and preventive medicine and a team
physician at the University of Utah in Salt Lake City.

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