Are skin traction and skeletal traction used for shoulder reduction?

From the Guidelines

Skin traction and skeletal traction are not typically used for shoulder reduction in the context of hemiplegic shoulder pain, as the primary focus is on managing pain, preventing further injury, and promoting recovery through techniques such as proper positioning, maintenance of shoulder range of motion, and motor retraining. The provided evidence from the American Heart Association/American Stroke Association guideline for adult stroke rehabilitation and recovery 1 emphasizes the importance of addressing shoulder pain in patients with stroke-related hemiplegia, highlighting the multifactorial nature of hemiplegic shoulder pain, which includes shoulder tissue injury, abnormal joint mechanics, and central nociceptive hypersensitivity.

Key considerations in managing hemiplegic shoulder pain include:

• Proper positioning to reduce shoulder subluxation and pain
• Maintenance of shoulder range of motion to prevent capsular stiffness and promote recovery
• Motor retraining to improve muscle strength and control
• Avoidance of aggressive passive range-of-motion exercises that could cause harm
• Potential use of slings during ambulation training to protect the shoulder from traction injury

The guideline also discusses various adjuvant treatments, including strapping, acupuncture, and neuromuscular electrical stimulation (NMES), but notes that the evidence for these interventions is limited or mixed 1. Therefore, the primary approach to managing shoulder pain in patients with hemiplegia should focus on evidence-based techniques that prioritize patient comfort, safety, and recovery.

From the Research

Traction Methods for Shoulder Reduction

• Skin traction and skeletal traction are not explicitly mentioned in the provided studies as methods for shoulder reduction 2, 3, 4, 5, 6.
• The studies discuss various reduction techniques, including traction-countertraction, special positioning, and leverage maneuvers 2, a two-step maneuver for inferior shoulder dislocations 3, Sool's method 4, the scapulohumeral distraction technique 5, and the Legg reduction maneuver 6.
• These techniques often involve gentle traction, countertraction, and manipulation of the scapula or humerus to achieve reduction, but do not specifically mention skin traction or skeletal traction.

Reduction Techniques

• The studies report on the effectiveness of different reduction techniques, including:
  • A painless technique for repositioning anterior shoulder dislocation using gentle traction and countertraction 2.
  • A two-step maneuver for reducing inferior shoulder dislocations 3.
  • Sool's method, which involves a simple and technically easy technique for reducing anterior shoulder dislocations 4.
  • The scapulohumeral distraction technique, which combines traction with scapula manipulation 5.
  • The Legg reduction maneuver, which is easy to perform and requires no premedication 6.

Effectiveness and Safety

• The studies report high success rates for the various reduction techniques, with minimal complications and no significant differences in neurovascular deficits before and after reduction 2, 3, 4, 5, 6.
• The scapulohumeral distraction technique was found to have a statistically significant decrease in relocation time and pain, with higher patient satisfaction rates compared to the classical Hippocratic technique 5.