Reduction of Shoulder Dislocations

Effective and timely reduction of shoulder dislocations can reduce pain and reduce the risk of neurovascular sequelae. In remote settings or other situations that preclude timely orthopedic consultation it may be appropriate for trained clinicians to perform the reduction.

The Basics

The glenohumeral joint is a ball and socket joint that provides articulation between the glenoid of the scapula and the proximal humerus.

The glenohumeral joint is regarded as one of the least stable joints in the human body and may account for 50% of all dislocation injuries.

Of these, approximately 97% are anterior dislocations, 2 to 3% are posterior and 0.5% inferior.

There is no single method of reducing these injuries that is successful every time and in every circumstance. A wise clinician will be familiar with several techniques and over time and with experience, they will develop a “game plan”; a series of techniques that are usually arranged with patient comfort as a first consideration.

Patient comfort is actually an important factor in maximizing efficacy. Without adequate pain management and muscle relaxation a safe and effective reduction is less likely. This process takes time and patience, rapid or aggressive movements only increase pain, resistance and muscle tension.

Before a Reduction

Before attempting a reduction it is important to ensure that the patient understands the procedure, the benefits and potential risks or complications and that you obtained express and informed consent.

Many practitioners have anxiety about causing injury by attempting a reduction. In fact, most neurovascular injuries occur at the time of injury; the dislocation itself being the causal mechanism. However, there is a small risk of the reduction exacerbating injury and a thorough and documented neurovascular exam – both before and after reduction – should be performed to record presence and/or change in injuries.

Physical Preparation:

Reductions are heavily reliant on cooperation from the patient and relaxation of the muscles. With shoulder reductions in particular there are two basic maneuvers that can be incorporated into several other techniques to help relax the muscles and provide optimal alignment. Whenever possible, encourage: