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If reduction is attempted immediate no analgesia is necessary as the pec major has not gone into spasm yet. Only a single attempt in indicated without an xray. If reduction is delayed analgesia can be provided with 20mL of 1% lidocaine injected directly into the sulcus created by the absent humeral head, or conscious sedation (narcotics/morphine +/- benzodiazepine/versed).
Neurovascular exam must be repeated and documented after reduction.
Analgesia Free Reduction Technique
- Postion: supine with affected arm at the sided and elbow extended.
- Maneuver: Gentle longitudinal traction accompanied by continuous abduction is applied. Continuous vertical oscillation of the upper arm is applied simultaneously as the arm is brought gently into abduction. After 90 degrees of abduction the arm is externally rotated and abduction continued gently to about 120 degres where reduction of the shoulder is expected.
- 82% effective.
- (Sayegh F, JBJS, 2006:88-B, SUPP I, 142)
- (Eachempati KK, JBJS 2004;86Am:2431)
Rockwood Traction/Countertraction Technique
- Position: supine with sheet wrapped in axilla, around the torso.
- Maneuver: Traction is applied to arm while assistant pulls countertraction using the sheet. Slight internal and external rotation is applied. Reduction is generally felt with a loud "clunk."
Milch Technique
- Position: supine with arm forward and elevated 90°
- Maneuver: arm is abducted with slight traction while the humeral head is pushed back into place with the thumb.
- O'Connor DR, Orthopedics 2006;29:528
Scapular Manipulation Technique
- Position: prone with shoulder slightly flexed and 5-15 lbs. of traction on the elbow
- Maneuver: scapula is rotated by pushing medially on the inferior tip and rotating the superior aspect outward.
Stimson Prone Technique
- Position: prone with involved shoulder hanging over the edge of the table. Apply 5-15lbs. of traction to the arm.
- Maneuver: allow weight to slowly pull shoulder back into postion, may take 15 minutes for reduction.
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