Shoulder Dislocation Reduction Techniques
The most effective approach to reduce a shoulder dislocation is to use the Stimson technique or the external rotation method, followed by proper immobilization in external rotation to prevent recurrence. 1
Initial Assessment
- Confirm dislocation with radiographs including anteroposterior (AP) views in internal and external rotation, and an axillary or scapula-Y view 2
- Assess for associated injuries including fractures (Hill-Sachs, bony Bankart), labral tears, and rotator cuff injuries 3
- Check neurovascular status before and after reduction attempts 1
Reduction Techniques
External Rotation Method
- Position patient supine with arm adducted to side
- Flex elbow to 90 degrees
- Slowly and gently rotate the arm externally until reduction occurs
- This technique has high success rates and is less traumatic than traditional methods 4
Stimson Technique
- Place patient prone with affected arm hanging off the edge of the bed with weight (5-10 lbs) attached to wrist
- Allow gravity to provide gentle traction for 20-30 minutes
- Gentle rotation may assist reduction 1
Scapular Manipulation
- Position patient prone or seated leaning forward
- Stabilize the superior aspect of the scapula
- Push the inferior tip of the scapula medially while an assistant applies gentle traction to the arm 1
Milch Technique
- Abduct the arm slowly while applying gentle traction
- Apply pressure on the humeral head with thumb to guide it into the glenoid 1
Post-Reduction Management
Immediate Care
- Confirm successful reduction with post-reduction radiographs 2
- Immobilize the shoulder in external rotation rather than internal rotation to reduce recurrence rates 4
- Provide appropriate analgesia (acetaminophen or ibuprofen if no contraindications) 1
Rehabilitation Protocol
- Maintain immobilization for 3-4 weeks 1
- Begin early physical therapy after immobilization period with focus on:
- Gentle stretching and mobilization techniques
- Progressive strengthening of rotator cuff muscles
- Neuromuscular re-education 1
- Avoid overhead pulleys during initial recovery as they encourage uncontrolled abduction 1
Special Considerations
Age-Related Factors
- Younger patients (especially under 35) have higher recurrence rates and may benefit from surgical consultation 2, 5
- Older patients are more likely to have rotator cuff tears with dislocation 3
Recurrent Dislocations
- Consider surgical intervention for patients with recurrent instability, especially young active individuals 6
- Arthroscopic stabilization has shown significantly lower recurrence rates (11%) compared to conservative management (75%) in young athletes 5
Complications to Monitor
- Neurological deficits requiring surgical intervention 1
- Complex regional pain syndrome 1
- Recurrent instability (particularly high in young patients) 5
- Associated rotator cuff tears or labral injuries 3