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[CLINICAL TECHNIQUES]

Self-Reduction of Anterior Shoulder Dislocation

Elizabeth A. Joy, MD

William O. Roberts, MD
Department Editor

THE PHYSICIAN AND SPORTSMEDICINE - VOL 28 - NO. 11 - NOVEMBER 2021


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 (figure 1). 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 (figure 2).

[Figure 1]

[Figure 2]

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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