Reducing shoulder dislocation without anaesthesia or assistant: Validation of a new reduction manoeuvre

Abstract

Purpose: Shoulder dislocation comprises 60% of all major joint dislocations worldwide and a number of reduction techniques are described in the literature with varying degrees of success. The description of a large number of techniques speaks for itself that no method is effective all the times and one should be acquainted with more than one technique. An ideal method of reduction should be simple, easily reproducible, relatively painless that can be performed unassisted without sedation or anaesthesia with minimal or no further complications. We report our results of using a novel method of anterior shoulder reduction described recently in the literature that claims to fulfil most of the characteristics of an ideal method if not all.

Methods: This prospective study was conducted in a tertiary care centre. All the cases of primary anterior shoulder dislocation presenting within three days of injury without any associated fracture or spine trauma with or without greater tuberosity fracture were included. The reduction was done using a novel method by orthopaedic residents in all cases. The need for a second reduction attempt or anaesthesia was considered a treatment failure. Time taken for reduction, pain felt during reduction and complications if any were noted.

Results: There were 47 (77.04%) males and 14 (22.95%) females with a mean age of (37.04 ± 12.63) years. The new technique was effective in locating a shoulder dislocation on the first attempt in 58 of the 61 dislocated shoulders (95.08%). The remaining three shoulders were reduced on second attempt by the same technique. Sedative, pre-medication or anaesthesia was not used in any case. The average time taken for the shoulder reduction was (130.5 ± 25.8) seconds and confidence interval (95%) 124-137 s. Iatrogenic complications were not seen in any of the patients.

Conclusion: This relatively painless technique of shoulder reduction is easy to acquire and practice in emergency department. The advantages of this manoeuvre and its associated safety may justly lead surgeons to select it as their primary method for reduction of anterior shoulder dislocations.

Keywords: External rotation manoeuvre; Prakash's manoeuvre; Shoulder dislocation.

Fig. 1

(A) Hold elbow with one hand and forearm with the other in the position of deformity without adducting or abducting. (B) Gently externally rotate the arm until it becomes near parallel to body, this position is maintained for a minute or so. (C) Gradually adduct the limb until the point of elbow comes over the body. (D) The arm is internally rotated so that the hand touches the opposite shoulder which confirms reduction.

Fig. 2

Pre-reduction radiograph (A) and post-reduction radiograph (B) of a patient with anterior shoulder dislocation, showing an uncomplicated reduction.

Fig. 3

Pre-reduction (A) and post-reduction radiograph (B) of anterior shoulder dislocation with greater tuberosity fracture, showing greater tuberosity in acceptable reduction.