Definition & Overview
A dislocation reduction refers to the different techniques used to reduce shoulder dislocations. These reduction techniques differ based on the amount of force exerted, the length of time they are performed, and the kind of equipment used. Timely and effective diagnosis and reduction of joint dislocations not only relieve pain and restore the shoulder’s normal movement and appearance but also help prevent treatment risks and complications.
Who Should Undergo and Expected Results
A dislocation reduction is necessary for all patients who suffer from any joint dislocation, which occurs when joints become unstable. Since the shoulder’s glenohumeral joint is one of the most unstable joints in the human body, it is the one most commonly affected. In fact, statistics show that as much as 50% of all joint dislocations affect the shoulder. Out of all these cases, up to 97% involve anterior dislocations, while posterior and inferior dislocations make up for only 2 to 4 percent and 0.5 percent of all cases, respectively.
Anterior dislocations, which often involve the subclavicular and intrathoracic joints, occur due to excessive force exerted on the shoulder joint. Since they are very common, anterior dislocations are usually detected and treated early. In contrast, posterior dislocations are sometimes misdiagnosed, leading to a delayed diagnosis and treatment and a higher risk of post-procedural complications. Ideally, posterior cases should be diagnosed and treated within the first six weeks following the injury.
Most joint dislocations can be easily and successfully treated using any of the common reduction techniques. A reduction is deemed successful if the patient experiences pain relief and his normal shoulder contour is restored. Any limit in the shoulder’s range of motion is also expected to disappear.
How is the Procedure Performed?
Dislocation reductions are performed differently depending on what technique is being used and what kind of dislocation is involved.
The most commonly used techniques for the reduction of anterior dislocations include the following:
Scapular manipulation – During a scapular manipulation, the patient is asked to sit down on an examination table with the affected arm stretched out in front of him at a 90-degree angle. The physician then reduces the dislocation by placing his palm on the shoulder’s lateral aspect and his thumb on the superior lateral border. With his other palm on the inferior scapular tip and his thumb on the inferior lateral border of the scapula, the physician slowly rotates the scapula’s inferior tip in order to move the glenoid fossa back into its proper position. This is one of the most commonly used techniques due to its low pain levels and high tolerance rating among patients.
External rotation – With the patient lying supine, the physician flexes the patient’s arm and rotates it externally at a gradual pace. Like the scapular manipulation, this boasts of high tolerance rating among patients, despite the fact that the procedure can be performed without sedation. However, the procedure’s success rating is lower than that of other techniques.
Milch technique – During a Milch dislocation reduction, the patient is asked to raise his arm laterally and position it behind his head. The physician then applies gentle traction in a longitudinal manner while rotating the arm in an external direction. This technique has a 70 to 90 percent success rates, with no major disadvantages.
Stimson maneuver – In a Stimson technique, the patient is asked to lie down on a stretcher with the dislocated shoulder and arm hanging off its edge. The stretcher is elevated at a height that allows the arm to dangle without reaching the floor. Once the patient is properly positioned, the physician begins rotating the affected arm outwards.
Spaso technique – During a Spaso reduction, the physician simply grasps the patient’s affected arm and applies gentle upward traction and external rotation. Once the muscles become relaxed, the physician applies direct pressure to the humeral head using his other hand, until an audible clicking sound is heard.
As for posterior dislocations, the most effective is the traction-counter traction technique, which is performed by carefully positioning the patient on an elevated bed. The height of the elevation is carefully measured to ensure the proper application of force. With a high success rating and with almost all physicians familiar with this technique, it is often used on patients with complicated dislocations, such as those who experience persistent pain and severe muscle spasms.
Thirdly, for inferior dislocations, the most commonly used techniques are as follows:
Axial or inline traction – In this technique, the physician stands behind the patient, who is lying supine on an examination table. While there, he applies axial traction to the affected arm.
Two-step reduction – Developed in 2006, the two-step dislocation reduction technique first converts an inferior dislocation to an anterior dislocation before attempting to perform a reduction.
These techniques typically involve two main steps: (1) the flexion of the elbow as a way to relax the affected tendons, and (2) the rotation of the humerus to release the affected ligament.
Regardless of which technique is used, the success of dislocation reductions is influenced by several factors, such as the appropriate pain relief method, effective muscle relaxation, and proper execution of any of the available reduction techniques. In general, reductions performed in a slow, consistent manner are more effective in treating dislocations while also minimizing pain and muscle spasms. On the other hand, if dislocations are reduced using quick movements, pain and muscle resistance are more likely.
Possible Risks and Complications
Prior to undergoing a dislocation reduction procedure, patients should be informed about the risks and potential complications linked with unsuccessful or incorrect attempts at reduction. These risks and complications include some neurovascular injuries, which explains why most clinicians perform a comprehensive neurovascular examination before and after a reduction procedure in order to detect any injuries caused by the procedure.
Other possible complications that may occur as a result of a shoulder dislocation and a failed reduction attempt include:
- Recurrent dislocations involving the same joint
- Avascular necrosis of the humeral head
- Chronic pain
- Degenerative disease
However, in every reduction procedure, perhaps the biggest risk the patient faces is that of a failed reduction attempt, and this risk increases depending on how complicated the dislocation is. If deemed necessary, the clinician may consult orthopedists and emergency medical personnel.
In the case of patients who fail to receive proper and effective treatment for their joint dislocation, long-term complications may also occur. These include a heightened susceptibility to repeat injuries and a higher risk of developing arthritis.
Mallia A. “Shoulder dislocation joint reduction technique.” Medscape. http://emedicine.medscape.com/article/109130-technique#c9
Welsh S. “Shoulder dislocation surgery treatment and management.” Medscape. http://emedicine.medscape.com/article/1261802-treatment
Blankart A.S.B. (2005). “The pathology and treatment of recurrent dislocation of the shoulder joint.” British Journal of Surgery. Vol. 26:101 pages 23-29. http://onlinelibrary.wiley.com/doi/10.1002/bjs.18002610104/abstract;jsessionid=BE009263924E64DE0D54915E900A0B87.f03t01