Reduction of anterior dislocation of shoulder

What to see: 

Xray shoulder joint: Head of humerus not in the glenoid cavity 

How to treat: 

1.Kocher's method 

2.Milch technique 

3.Stimson's method

KOCHER'S METHOD

• Flexion of the elbow to a right angle

• traction in the line of the humerus

• external rotation of the arm: this brings the head of the humerus to face forwards 

• the elbow is pulled across the body: this adducts the humerus and disengages the humeral head 
• internal rotation of the arm: this lets the humeral head fall back into the glenoid

MILCH METHOD 

• Have the patient lie on a stretcher; the patient can be either supine or prone based on his or her comfort

• Have the patient abduct the affected arm to place their hand behind their head, if they are able, and then straighten the arm at the elbow

• If the patient cannot do this unassisted, then grab patient's arm at either the elbow or the wrist and guide arm into full abduction

• With the arm fully abducted, apply gentle longitudinal traction and gentle external rotation to achieve reduction

 

 

• If reduction does not occur quickly, apply gentle cephalad pressure to the humeral head while continuing to hold traction

STIMSON'S METHOD 

• The patient is placed in the prone position on an elevated stretcher/bed

• The affected shoulder should be off the edge of the stretcher/bed, hanging downward in 90° of forward flexion

• The stretcher/bed should be high enough to allow the patient's arm to dangle without touching the floor

• To prevent the patient from sliding off the stretcher, he or she is tightly strapped down with a sheet, and 2-10 kg of weight is securely fastened to the wrist of the affected arm to provide continuous traction

• If weights are unavailable, two to four 1L containers of normal saline can be used

• The patient is instructed to maintain this position for at least 15-20 minutes or until reduction is accomplished

Written by our guest author Swapnil Bhagat

Illustrations by Anveshi Nayan
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