A simple procedure for reducing anterior shoulder dislocation without anesthesia: Traction, abduction and external rotation.

ABSTRACT

General anaesthesia is normally used for facilitating reduction of anterior dislocation of the shoulder. To avoid anaesthesia or other medication, a simple technique of reduction of the shoulder dislocation by applying gentle traction along the extremity in elbow extension and continuing abduction with external rotation of the shoulder has been used. Since 1975, this simple procedure has been used in 32 patients who sustained anterior dislocation of the shoulder. The dislocation was a recurrence in 11 of the patients and a primary in 21 patients. The mechanism of reduction was studied by observing the relationship of the humeral head and glenoid using portable X-ray in anteroposterior and transaxillary views of the shoulder in nine patients. The results showed that there was no need for anaesthesia. All shoulder joints were successfully reduced without the need for assistance or the use of instruments. The mechanism of reduction showed that when the shoulder was 0-90 degree abducted during applying the traction, the humeral head rose upwards and closed outwards to the centre of the glenoid fossa, but remained anterior to the glenoid . When the shoulder was externally rotated during continuing abduction from 90 to 110 degrees, there was disengagement of the posterolateral aspect of the humeral head from the anterior aspect of the glenoid rim. Under those conditions, successful reduction of the shoulder was achieved.