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Dislocation Reduction of the Shoulder Joint

  • Editor(s): Todd W Thomsen, MD, Gary S Setnik, MD, FACEP
  • Section Editor(s): Phillip M Harter, MD
  • Contributor(s): Carmie Chan, MD
PRE-PROCEDURE
INDICATIONS
  • Anterior shoulder dislocations
  • Posterior dislocations
  • Other dislocations
    • Inferior dislocations of the shoulder, known as luxatio erecta
CONTRAINDICATIONS

Shoulder dislocations require reduction; however, dislocation associated with humeral fracture may require open reduction.
ANATOMY
  • Humerus
    • The anatomic neck of the humerus is the boundary between the head of the humerus and the greater tubercle. The surgical neck is the area of the humerus that narrows just distal to the greater tubercle.
  • Scapula
    • The scapula articulates with the shoulder via the glenoid fossa and the acromion.
  • Neurovascular structures
    • The subclavian artery continues into the arm as the axillary artery and gives rise to several large branches in the shoulder, including the thoracoacromial, lateral thoracic, subscapular, and posterior circumflex humeral arteries.
    • The brachial plexus arises at nerve roots C5 through T1 and travels through the neck musculature and inferior to the clavicle into the arm through the axillary region.
AP view of anterior subcoracoid dislocation. A = acromion, C = coracoid, G = glenoid, HH = humeral head, S = scapula, Hu = humerus.
Figure 3 :  AP view of anterior subcoracoid dislocation. A = acromion, C = coracoid, G = glenoid, HH = humeral head, S = scapula, Hu = humerus.

Shoulder anatomy.
Figure 8 :  Shoulder anatomy.


PROCEDURE
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Perform a neurovascular exam prior to the reduction.
Figure 10 :  Perform a neurovascular exam prior to the reduction.

The Stimson maneuver.
Figure 12 :  The Stimson maneuver.

1: Stabilize the superior aspect of the scapula. 2: Push the inferior tip of the scapula toward the spine.
Figure 15 :  1: Stabilize the superior aspect of the scapula. 2: Push the inferior tip of the scapula toward the spine.

External rotation method.
Figure 16 :  External rotation method.

Milch technique.
Figure 17 :  Milch technique.

Apply traction using the weight of your body.
Figure 20 :  Apply traction using the weight of your body.

Spaso technique.
Figure 21 :  Spaso technique.

Posterior dislocation reduction is similar to the traction-countertraction technique.
Figure 22 :  Posterior dislocation reduction is similar to the traction-countertraction technique.

1: Counter-traction, 2: Overhead traction, 3: Cephalad pressure on humeral head.
Figure 24 :  1: Counter-traction, 2: Overhead traction, 3: Cephalad pressure on humeral head.


POST-PROCEDURE
CARE
  • Recheck the neurovascular status.
  • Confirm reduction of the dislocation.
  • Obtain postreduction radiographs.
  • Immobilize the reduced shoulder.
  • Arrange orthopaedic evaluation.
  • Prescribe appropriate analgesia.
COMPLICATIONS
  • Fractures of the humeral neck are frequently displaced with attempts at closed reduction and this often results in avascular necrosis of the humeral head.5
  • Neurovascular injury
  • Joint instability and recurrent dislocation
Confirm reduction of the dislocation.
Figure 25 :  Confirm reduction of the dislocation.

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