Comparison of the Closed Shoulder Reduction Techniques: An Evidence-to-Practice Review

Abstract

The shoulder joint is one of the most dislocated joints in the body. It does not have substantial bony support which allows for a large range of motion. Shoulder joints most commonly dislocate anteriorly, and less often dislocate posteriorly and inferiorly. There is a myriad of ways to reduce a shoulder dislocation including closed and open techniques. The purpose of this evidence-to-practice review is to summarize which closed shoulder reduction techniques are most effective and apply those results to an athletic training setting. The authors of this guiding systematic review studied multiple articles that compared different closed shoulder reduction techniques on the following criteria: pain experienced by the patient, ease of technique for clinician (time to reduce the shoulder joint), success rate, and complication rates. The authors chose to include randomized control trials, prospective studies, and retrospective studies. The literature revealed that the scapular manipulation technique had the best outcomes in all the criteria, however, every patient that had a shoulder dislocation that was reduced using that method also had intravenous analgesics. The Fast, Reliable, and Safe (FARES) method was found to be the third most successful and least painful during relocation and was often used without intravenous analgesics. Based on rate of success and patient comfort during reduction, the FARES method is the best option, suggesting that it should be taught to healthcare providers more often. Depending on the state practice act and physician oversight, athletic trainers who are allowed to reduce dislocations should be informed and educated on how to properly reduce and also allow for the best possible outcome and comfort for the patient.