Chapter 53

### Indications

• • 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.

### Contraindications

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

### Equipment

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

• A bed sheet.

• An assistant to perform countertraction.

### Risks

• • 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).

### Pearls and Tips

• • 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.

### Patient Preparation

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

### Patient Positioning

• • Lying supine on the table.

### Anatomy Review

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

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

###### Figure 53–1.

Anatomy of shoulder.

### Procedure

• • 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).

• • 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.

###### Figure 53–2.

Applying traction to shoulder.

### Interpretation and Monitoring

• • 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 ...

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