ANTERIOR SHOULDER DISLOCATION


There are four distinct types of anterior shoulder dislocation:

DIAGNOSIS

TREATMENT

Reduction methods for anterior dislocations:

  1. Modified hippocratic technique: This method uses traction and countertraction. Place pt supine with their arm abducted & the elbow flexed 90 degree. A sheet is placed across the thorax of the pt & tied around the waist of the assistant. Another sheet is placed around pts flexed elbow and the clinician's waist. Gradually apply traction while as assistant provides countertraction. Gentle internal & external rotation may aid reduction
     
  2. Milch (forward elevation): With pt supine, slowly abduct and externally rotate the arm to the overhead position. Apply gentle traction with the elbow fully extended. If reduction is not achieved, attempt to manipulate the humeral head into the glenoid fossa with the free hand.
  3. Scapular manipulation: Scapular manipulation accomplishes reduction by repositioning the glenoid fossa rather than the humeral head. The first step is to apply traction to the pts arm held in 90 degree of forward flexion. This can be accomplished in the prone position or in a seated position with an assistant applying traction. Position the arm in slight external rotation. Push the scapular tip as far medially as possible while stabilizing the superior aspect of the scapula with the other hand. A small amount of dorsal displacement of the scapula tip is recommended.
  4. External rotation (Hennepin technique): Place the pt supine with the arm adducted to the side. With the pts elbow flexed to 90 degree, slowly & gently externally rotate the arm. No traction is applied. Reduction is subtle & usually occurs before reaching the coronal plane.


     
  5. Aronen technique: This technique is most useful when reduction is simple to achieve, as in recurrent dislocations or immediately after injury before muscle spasm & swelling have occurred. This technique can be taught to pts with recurrent dislocations, as self-reduction may be the only method available to the in certain situations.
    The pt is seated on a gurney with the ipsilateral leg & knee in flexion. Pts are instructed to clasp their hands around ipsilateral knee & then relax the shoulder muscle, thereby allowing the weight of the lower limb to provide gentle inline traction. countertraction is applied by the pts' upper body weight & their own paraspinous muscles. Taping the clasped hand together can aid reduction.
  6. Recheck pulse, motor, sensation, and apply Velpeau dressing or shoulder immobilizer.
  7. Urgent Orthopedic follow-up

COMPLICATIONS