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Indications

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  • • Any dislocated shoulder (ie, the humeral head is not in concentric relationship within the glenoid fossa).

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• An anterior shoulder dislocation is most common. The patient holds the arm in abduction and external rotation.
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• Obtain radiographs, including an axillary view, to detect possible fracture before any reduction maneuvers.
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Contraindications

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  • • Any associated fracture. Patients with fractures should be evaluated by an orthopedic surgeon before a reduction maneuver is performed.

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Equipment

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  • • Medications for muscle relaxation and an appropriate level of conscious sedation.

    • A bed sheet.

    • An assistant to perform countertraction.

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Risks

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  • • Inability to reduce the shoulder.

    • Additional damage to the humeral head, glenoid, or labrum during the reduction maneuver.

    • Traction injury to the brachial plexus and especially the axillary nerve (rare).

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Pearls and Tips

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  • • An adequate level of conscious sedation is critical. The patient must have muscle relaxation and should not be “fighting” the reduction maneuver.

    • Do not let go once traction is applied to the arm.

    • Continuous traction helps relax the muscles that may be holding the humeral head out of the glenoid fossa in a shortened position.

    • Perform and document a neurovascular examination both before attempting reduction and after the reduction.

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Patient Preparation

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  • • A bed sheet is placed around the patient’s chest.

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Patient Positioning

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  • • Lying supine on the table.

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Anatomy Review

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  • • The shoulder joint consists of the humeral head, which articulates with the glenoid of the scapula (Figure 53–1).

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  • • Although a cartilaginous labrum on the glenoid helps provide additional stability, it is an inherently unstable joint.

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Procedure

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  • • After sedation and muscle relaxation, an assistant provides countertraction while the physician holds the arm at the elbow and applies traction by pulling the arm in a longitudinal direction (Figure 53–2).

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  • • Slight internal and external rotation of the shoulder is used and usually a “clunk” is felt as the humeral head eases into the glenoid and the shoulder reduces.

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Interpretation and Monitoring

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  • • Obtain radiographs (2 views) to confirm the reduction.

    • The patient is placed in a shoulder immobilizer.

    • If an immobilizer is not available, a sling with an elastic bandage wrap holding the arm to ...

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