Anteroinferior shoulder dislocation: an auto-reduction method without analgesia

Abstract

Objectives: To describe a new reduction method for anteroinferior shoulder dislocations.

Design: Retrospective for the first thirty patients; prospective for the remaining seventy patients.

Setting: University hospital.

Patients: One hundred patients with anteroinferior shoulder dislocations.

Interventions: X-rays in two different projections were taken. The patient then was asked to sit on a relatively hard surface. The wrists were protected. The patients's forearms were placed around the homolateral knee, which is flexed at 90 degrees. The head of the examination table was lowered, and the patient was asked to lean backward with his or her neck in hyperextension. The patient had to push his or her shoulders (shrug) anteriorly, thus creating a rational movement of the scapula around a vertical axis.

Main outcome measures: The authors analyzed initial prereduction x-rays and established a classification system based on the position of the humeral head, then assessed the success rate of the new technique with respect to the radiologic study.

Results: When using the reduction method described by Boss-Holzach-Matter, the authors attained an overall success rate of 60 percent, with a mean reduction time of three minutes and a time interval varying from fifteen seconds to nine minutes.

Conclusion: The Boss-Holzach-Matter method is a reduction technique for anteroinferior shoulder dislocations that can be used without premedication or anesthesia. The authors recommend it for those patients who are not going to be sedated and for whom "quick" reduction and early discharge is desirable.