Use of the Scapular Manipulation Method to Reduce an Anterior Shoulder Dislocation in the Supine Position

doi:10.1016/S0196-0644(96)70303-7

Annals of Emergency Medicine

Volume 27, Issue 1, January 1996, Pages 92-94

https://doi.org/10.1016/S0196-0644(96)70303-7 Get rights and content

Abstract

We report the successful use of the scapular manipulation method to reduce an anterior shoulder dislocation in a multiply traumatized patient in the supine position. We discuss the treatment options for multiply traumatized patients with anterior shoulder dislocations in whom cervical spine injury is a possibility. Although larger patient studies are necessary for confirmation, we show that in this particular case the scapular manipulation technique was safely employed. To our knowledge, this is the first reported case of use of the scapular manipulation method with the patient in the supine position. [Doyle WL, Ragar T: Use of the scapular manipulation method to reduce an anterior shoulder dislocation in the supine position. Ann Emerg Med January 1996;27:92-94.]

Section snippets

INTRODUCTION

Anterior shoulder dislocations are commonly seen after blunt trauma and are the most common of all dislocations seen in American emergency departments.¹ Several methods exist for reducing anterior shoulder dislocations. Some methods require that the patient lie supine (the traction-countertraction technique², the Kocher procedure³, the Hippocratic maneuver², external rotation⁴, and the Milch-Cooper method⁵); others require the prone or sitting position (scapular manipulation⁶, the Stimson

CASE REPORT

A 30-year-old man was transported to our ED by paramedics after he was struck by a small truck when he ran into the street to rescue his cat. He was thrown into a group of bushes at the roadside, where he was found by paramedic personnel. On presentation to the ED, the patient complained of severe pain in his right shoulder and in his left lower abdomen. He denied any loss of consciousness but admitted to confusion at the scene of the accident. He reported a history of recurrent right shoulder

DISCUSSION

Anterior shoulder dislocation is the most commonly seen dislocation in emergency medicine.¹ Several techniques have been developed to reduce such injuries and have been extensively reported.2, 3, 4, 5, 6, 7 The scapular manipulation method has been shown to be both efficacious and relatively painless6, 8, and it often can be performed without the use of sedation or analgesia.⁸ Our patient had to remain supine because of the possibility of an undetected cervical spine injury. Previous techniques

References (8)

MJ Mirick et al.
External rotation method of shoulder dislocation reduction
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RU Kothari et al.
Prospective evaluation of the scapular manipulation technique in reducing anterior shoulder dislocations
Ann Emerg Med
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RM McNamara
Reduction of anterior shoulder dislocations by scapular manipulation
Ann Emerg Med
(1993)
DF Danzl et al.
Closed reduction of anterior subcoracoid shoulder dislocation
Orthop Rev
(1986)

There are more references available in the full text version of this article.

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Shoulder Dislocations in the Emergency Department: A Comprehensive Review of Reduction Techniques
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McNamara described this in the seated position by having a second clinician perform traction in forward flexion with 1 hand pulling the patient's arm forward while the other hand applies a counterforce at the clavicle to stabilize the patient's chest (112). Doyle and Ragar described this in the supine position with 1 clinician elevating the extremity in 90° of forward flexion (117). Another approach, the single-operator scapular manipulation and traction-countertraction (SOSMAT), has also been described (118).
Shoulder dislocations are a common presentation to the emergency department and one of the most frequent types of joint dislocations. Studies have found that delays from presentation to first reduction attempt and failed attempt at initial reduction are associated with lower rates of overall reduction success.
This article reviews 26 total reduction techniques, as well as a variety of modifications to these techniques. Each technique has distinct advantages and limitations associated with its use. While there are limited data comparing specific techniques, the individual success rates of most maneuvers range from 60–100%.
It is essential for emergency physicians to be familiar with multiple different reduction techniques in case the initial reduction attempt is unsuccessful or patient-specific characteristics limit the ability to perform certain techniques. This article reviews several reduction maneuvers for shoulder dislocations, variations on these techniques, and advantages and disadvantages for each approach. It is intended to serve as a resource for those interested in expanding their knowledge of shoulder reduction techniques.
A systematic and technical guide on how to reduce a shoulder dislocation
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Thereafter the practitioner pushes the tip of the inferolateral scapular edge medially rotating upward, initiating the reduction (Fig. 15). This technique can be modified by having the patient in supine or seated position.55–57 This variation combines the Stimson's maneuver and the scapular manipulation technique; Stimson's maneuver is tried first, if that fails the scapular manipulation technique is added.58
Our objective is to provide a systematic and technical guide on how to reduce a shoulder dislocation, based on techniques that have been described in literature for patients with anterior and posterior shoulder instability.
A PubMed and EMBASE query was performed, screening all relevant literature on the closed reduction techniques. Studies regarding open reduction techniques and studies with fracture dislocations were excluded.
In this study we give an overview of 23 different techniques for closed reduction and 17 modifications of these techniques.
In this review article we present a complete overview of the techniques, that have been described in the literature for closed reduction for shoulder dislocations. This manuscript can be regarded as a clinical guide how to perform a closed reduction maneuver, including several technical tips and tricks to optimize the success rate and to avoid complications.
There are 23 different reduction techniques with 17 modifications of these techniques. Knowledge of the different techniques is highly important for a good reduction.
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Scapular manipulation is performed with slight traction on the affected arm, which is held in forward flexion at the shoulder to 90°. This may be accomplished with the patient prone, seated, or in the supine position (provided that the patient is positioned with the scapula exposed) (7,12,13). Most operators find this technique easier to perform in the prone or seated positions.
The shoulder is the most commonly dislocated large joint presenting to American Emergency Departments (ED). Anterior dislocations account for the great majority of these dislocations. Most anterior shoulder dislocations can be reduced in the ED using a variety of reduction techniques. The traction-countertraction technique is quite familiar to most Emergency Physicians, however, many other effective methods of reduction have been described. No method has proven 100% successful, and occasionally multiple attempts using different techniques are required to effect reduction. This article reviews some of the other techniques used to reduce anterior shoulder dislocations, variations reported on these techniques, and their success rates, advantages, and disadvantages.
Acute complications associated with shoulder dislocation at an academic Emergency Department
2003, Journal of Emergency Medicine
Shoulder dislocation is the most frequent dislocation treated in the Emergency Department (ED). Orthopedic literature cites up to a 55% incidence of fracture, vascular or neurologic injury associated with this injury, but these studies suffer from referral bias. No large ED series has been reported. This retrospective chart review was conducted in an academic ED for patients with shoulder dislocation presenting July 1, 1995–June 30, 2000. There were 263 charts identified; 73 were miscoded and 5 were lost, leaving 190 for analysis. Mean age was 34.3 years. Fifty-five patients had at least one fracture (29%), 48 of which (76%) were of the Hill-Sachs type. Despite presence of a fracture, all shoulders underwent successful ED reduction. Sensory nerve deficits were found in 24 (12.6%), which persisted after reduction in 25% of these patients. No vascular injuries were identified. The finding of fracture in 33% of patients with shoulder dislocation is in the range of rates reported in the orthopedic literature (15–55%). The finding that, despite the presence of a fracture, all underwent successful closed reduction is important, as one-third of these patients will have this condition. Neurologic deficits in 12% is significantly lower than the 21–65% reported in the orthopedic literature. Although complications associated with shoulder dislocation were relatively common, they did not significantly affect ED management.

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^☆: From the Department of Emergency Medicine, Providence Yakima Medical Center, Yakima, Washington.

^☆☆: Address for reprints: William L Doyle, MD, Providence Yakima Medical Center, 110 South Ninth Avenue, Yakima, Washington 98902, 509-575-5060

^★: Reprint no. 47/1/69557

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Use of the Scapular Manipulation Method to Reduce an Anterior Shoulder Dislocation in the Supine Position☆,☆☆,★

Abstract

Section snippets

INTRODUCTION

CASE REPORT

DISCUSSION

JACEP

Ann Emerg Med

Ann Emerg Med

Closed reduction of anterior subcoracoid shoulder dislocation

Orthop Rev