Shoulder Reduction

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SAMPLE EXCERPT
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PRE-PROCEDURE
INDICATIONS
  • Shoulder dislocation
CONTRAINDICATIONS

The following should generate an immediate orthopedic consult to manage the reduction:

  • Any shoulder dislocation other than a subcoracoid, anterior dislocation
  • Any fracture dislocation of the shoulder
  • Any vascular compromise of the upper extremity (requires immediate intervention)
  • Any neurologic defect other than a mild axillary nerve finding
  • Other fractures of the shoulder, neck, ribs, or upper extremity
  • Previous orthopedic surgery for chronic or recurrent shoulder dislocations
EQUIPMENT
  • Stretcher
  • Soft restraints
  • Cloth tape
  • Weights
  • Conscious sedation forms and providers
  • Analgesia
  • Muscle relaxant
  • Narcotics
  • Benzodiazepines
  • Reversal agents
  • Shoulder immobilizer
ANATOMY
  • Most frequently, the physician encounters a dislocation in which the humeral head has been pulled anteriorly and medially by spasm of the chest wall muscles. This is the subcoracoid, anterior dislocation. This dislocation usually is caused when an abducted, extended, and externally rotated upper extremity has met with resistance.
  • Scapula
    • The supraspinatus tendon, subscapularis tendon, teres minor tendon, infraspinatus tendon, and capsular ligament hold the proximal humerus to the glenoid fossa of the scapula.
  • Neurovascular structures
    • The axillary artery gives rise to the thoracoacromial artery, the lateral thoracic artery, the subscapular artery, and the posterior circumflex humeral artery.
    • At the level of the axilla, the brachial plexus forms the lateral, posterior, and medial cords; these, in turn, give rise to the musculocutaneous, axillary, radial, median, and ulnar nerves.

PROCEDURE
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  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • After the shoulder has been reduced, hold the limb in internal rotation and adduction with a sling and swath device.
  • Conduct a careful postreduction neurovascular assessment.
  • Obtain appropriate postreduction radiographs.
  • A repeat radiographic axillary view (and sometimes a postreduction CT scan) also is required.
  • After the designated period of immobilization has ended, assign a gentle strengthening program, with particular emphasis on the shoulder internal rotators. Unrestricted external rotation and lifting activities usually are not permitted for a period of 3 months. Usually, immobilization for a period of 4 to 6 weeks is warranted after a successful reduction has been performed.
COMPLICATIONS
  • Inability to reduce the dislocation
  • Iatrogenic fracture
  • Neurovascular damage
  • Redislocation
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