Reduction Of Shoulder Dislocation Research Articles

Patient factors associated with unplanned sedation after intra-articular lidocaine for shoulder dislocation

BackgroundRecent evidence suggests that intra-articular lidocaine (IAL) is an appropriate analgesic alternative to intravenous sedation (IV sedation) during shoulder dislocation reduction, however little is known about patient factors associated with IAL failure and need for subsequent IV sedation. Avoiding crossover is important, as repeated reduction attempts have been previously shown to increase the rate of procedural complications. ObjectivesTo identify patient level factors associated with crossover from IAL to IV sedation and associated complication rates and operational impacts. MethodsThis retrospective observational cohort study evaluated the patient characteristics associated with crossover to unplanned IV sedation after IAL among adult patients undergoing ED reduction of an isolated, acute anterior shoulder dislocation from 2013 to 2021 in an urban, academic hospital system. Univariate analysis and multivariate logistic regression were used. ResultsIn total, 630 participants were identified who received IAL or procedural sedation. Of these, 182 (28.9 ​%) received IAL of whom 49 (26.9 ​%) subsequently required unplanned IV sedation. Participants had 1.205 (95 ​% CI 1.030, 1.418) fold increase in odds of unplanned sedation for every 10-year increase in age. Crossover to IV sedation was associated with greater rates of adverse events, ED length of stay, and quantity of opioids received compared to either IAL or IV sedation alone. ConclusionsParticipants with unplanned IV sedation after IAL had more adverse events than those who received either method alone. Older age was associated with unplanned sedation after IAL. Prospective studies are needed to further define patient factors likely to contribute to failure of IAL.

CORR Insights®: Is Ultrasound-guided or Landmark-guided Intra-articular Lidocaine Injection More Effective for Pain Control in Anterior Shoulder Dislocation Reduction? A Randomized Controlled Trial.

CORR Insights®: Is Ultrasound-guided or Landmark-guided Intra-articular Lidocaine Injection More Effective for Pain Control in Anterior Shoulder Dislocation Reduction? A Randomized Controlled Trial.

Rate of Successful Shoulder Reduction on First Confirmatory Imaging in the Emergency Department

BackgroundManagement of acute shoulder dislocation in the emergency department (ED) is common. ObjectiveThis study describes the rate, risk factors, and length of stay (LOS) associated with shoulder dislocation reduction failure in the ED. MethodsThe study was a retrospective case–control study of patients 18 years and older presenting to the ED with acute shoulder dislocation who underwent attempted reduction. Patients with successful reduction on post-reduction first confirmatory imaging are compared with those requiring multiple attempts. ResultsOf 398 ED encounters when a shoulder reduction was attempted in the ED, 18.8% (75/398 [95% CI 15.2–22.9%]) required multiple reduction attempts. Patients with successful reduction on first confirmatory imaging were more commonly male (80.2% [95% CI 75.6–84.3%] vs. 68.0% [95% CI 56.8–77.8%]; p = 0.0220), discharged home from the ED (95.4% [95% CI 92.6–97.3%] vs. 84.0% [95% CI 74.4–91.0%]; p = 0.0004), reduced using a traction/countertraction technique (42.1% [95% CI 36.8–47.6%] vs. 29.3% [95% CI 19.9–40.4%]; p = 0.0415), and less likely to have a pre-reduction fracture (26.0% [95% CI 21.4–31.0%] vs. 45.3% [95% CI 34.4–56.7%]; p = 0.0010). Mean length of stay (LOS) for those with successful reduction on first confirmatory imaging was 2 hours and 8 minutes shorter than for those with more than one attempt (p < 0.001). ConclusionsThe rate of failed first-pass reduction is higher than previously reported. Furthermore, the ED LOS was significantly longer in patients requiring multiple attempts. Knowledge of the failure rate and risk factors may raise physician awareness and guide future studies evaluating approaches for verification of reduction success.

Effectiveness of the Cunningham technique for shoulder dislocation reduction and its role in providing analgesia and muscle relaxation as an adjunctive method

BackgroundShoulder dislocation, particularly anterior dislocation, is a common orthopedic injury often presenting in emergency care settings, characterized by significant pain and muscle spasms. Prompt reduction is essential to alleviate symptoms and restore function. The Cunningham technique employs gentle pulling and massage motions targeted at the muscles and has emerged as a promising method for reducing anterior shoulder dislocations. However, its reported success rates vary widely across studies, and questions remain regarding its efficacy, particularly in cases of failure. This study aims to evaluate the effectiveness of the Cunningham technique for reducing anterior shoulder dislocations and its potential role in providing analgesia and muscle relaxation as an adjunctive method. MethodsA retrospective study was conducted on patients presenting with acute anterior shoulder dislocation at a single center. Reduction using the Cunningham technique was performed initially, followed by the external rotation technique if unsuccessful. Procedural sedation and analgesia were administered if the reduction was still not achieved, and shoulder dislocation reduction was performed again through the external rotation method. The patients’ VAS scores were recorded and evaluated the Cunningham technique's effectiveness in reduction and whether it increases the effectiveness of other techniques applied for reduction by lowering the VAS score, even in cases where it is not effective. ResultsA total of 61 patients were included in the study. The reduction was performed using the Cunningham technique in 34.4% (21/61) patients, the external rotation technique in 47.5% (29/61) patients, and the external rotation technique with PSA in 18% (11/61) patients. Significant differences were observed in the duration of hospital stay among the three techniques, with ER with PSA resulting in the longest stay. VAS scores showed significant improvements from initial presentation to post-reduction in all three groups. A significant decrease in pre-reduction VAS scores was observed during the transition from the Cunningham technique to other techniques. ConclusionThe Cunningham technique showed effectiveness in reducing anterior shoulder dislocations, providing analgesia, and muscle relaxation. It demonstrated favorable outcomes as an initial reduction technique, with the external rotation technique used as a subsequent option. Further studies comparing the success rates and complications of the Cunningham technique with other reduction methods are warranted to establish its role in clinical practice.

Suprascapular nerve block in shoulder dislocation

Background: The suprascapular nerve is the main sensitive nerve of the shoulder. In 1973, the suprascapular nerve block was applied in the reduction of a series of cases of acute shoulder dislocations using mepivacaine. Barber described a method using anatomic landmarks to locate and block the suprascapular nerve. Methods: This study was approved by our Institutional Review Board and all patients signed an informed consent. We performed a prospective longitudinal study, characterized by a consecutive series of first episode of traumatic shoulder dislocation in patients over 18 years old. From July 2020 to April 2022, 50 cases were included in our study. All patients had their pain evaluated before the blockage, during the reduction and after the reduction. We used the Barber method for the blockage and the Spaso maneuver for reduction. Results: From the 50 cases, 29 were males (58%). The mean age was 58,7 years. 47 cases were anterior dislocations, 2 cases posterior dislocations and one case of luxatio erecta. The mean initial VAS was 7.5 points (minimal 4, maximum 10). The main score during the reduction maneuver was 2 points (0-5) and the main score after reduction was 0,4 (0-3). In only one case, reduction was not successful after 3 attempts, and reduction was performed under sedation. Conclusions: The suprascapular nerve block by Barber’s method proves to be a secure, effective and simple procedure to aid the shoulder dislocation reduction in the emergency room, without the need of any imaging resources.

Is Ultrasound-guided or Landmark-guided Intra-articular Lidocaine Injection More Effective for Pain Control in Anterior Shoulder Dislocation Reduction? A Randomized Controlled Trial.

Effective pain control during reduction of shoulder dislocation is essential for patient comfort. However, there is a lack of comprehensive research comparing the efficacy of different pain management techniques, specifically landmark-guided and ultrasound-guided intra-articular analgesic injections. Among patients undergoing closed reduction of a shoulder dislocation, were there differences between an intra-articular shoulder injection placed using anatomic landmarks and an ultrasound-guided intra-articular injection in terms of (1) pain before versus after the injection and pain before injection versus after the reduction, or (2) length of stay in the emergency department and complications of the procedure? Between August 2021 and March 2023, 28 patients with anterior shoulder dislocation were treated at the emergency department of a tertiary referral care center. They were randomly assigned to either the landmark-guided or ultrasound-guided intra-articular lidocaine injection group. Differences in pain levels between preinjection and postinjection, preinjection and postreduction, length of hospital stay, and complications were assessed and compared between the two groups. Patients were followed for 2 weeks. There were no between-group differences in terms of age, gender, baseline pain score, and any other relevant factors. There were no differences between the groups in terms of pain reduction between preinjection and postinjection (landmark-guided: ΔVAS 2.8 ± 1.1, ultrasound-guided: ΔVAS 2.9 ± 1.0, mean difference -0.14 [95% confidence interval -0.97 to 0.68]; p = 0.72) or between preinjection and postreduction (landmark-guided: ΔVAS 6.6 ± 2.1, ultrasound-guided: ΔVAS 5.8 ± 1.8, mean difference 0.79 [95% CI -0.74 to 2.31]; p = 0.30). There were no differences in length of stay in the emergency department (landmark-guided: 162 ± 38 minutes, ultrasound-guided: 184 ± 73 minutes, mean difference 22 minutes [95% CI -67 to 24]; p = 0.33), and no complications were reported in either group during the 2-week follow-up period. The results of the landmark-guided technique were not different from those of ultrasound-guided injection in terms of lower pain levels, length of stay, and complications. These findings provide valuable guidance for orthopaedic surgeons, enabling them to make informed decisions based on their expertise and available resources. Level I, therapeutic study.

Shoulder reduction on the scene: current practice and outcome of the Bavarian Mountain Rescue Service—a prospective observational study

Out-of-hospital reduction of shoulder dislocations using the Campell method is recommended by the International Commission for Alpine Rescue and applied in the Bavarian Mountain Rescue Service (Bergwacht Bayern, BWB) protocols. This prospective observational study includes patients out-of-hospital with suspected shoulder dislocation and treated and evacuated by the BWB. Data were systematically collected using three questionnaires: one completed on-site by the rescuer, the second in hospital by the physician and the third within 28 (8–143) days after the accident by the patient. The suspected diagnosis of shoulder dislocation was confirmed in hospital in 37 (84%) of 44 cases. Concomitant injuries in other body regions were found in eight (16%) of 49 cases and were associated with incorrect diagnosis (p = 0.002). Younger age (p = 0.043) and first shoulder dislocation event (p = 0.038) were associated with a higher success rate for reduction attempts. Out-of-hospital reduction of shoulder dislocations leads to significant pain relief and no poorer long-term outcome. Signs that are associated with successful out-of-hospital reduction (younger age and first event), but also those that are associated with incorrect diagnosis (concomitant injuries) should be considered before trying to reduce shoulder dislocation on site. The considerable rate of incorrect first diagnosis on site should give rise to an intensive discussion around teaching and training for this intervention.Trial registration: This study is registered with the German Registry for Clinical Trials (DRKS00023377).

276 Inhaled Nitrous Oxide for Shoulder Dislocation Reduction in the Emergency Department: A Retrospective Case Series

276 Inhaled Nitrous Oxide for Shoulder Dislocation Reduction in the Emergency Department: A Retrospective Case Series

275 Factors Associated With Conversion to Procedural Sedation After Intra-articular Lidocaine Administration for Emergency Department Anterior Shoulder Dislocation Reduction

275 Factors Associated With Conversion to Procedural Sedation After Intra-articular Lidocaine Administration for Emergency Department Anterior Shoulder Dislocation Reduction

Role of Atropine in Attenuating the Side Effects of Propofol in Procedural Sedation in Anterior Shoulder Dislocation Reduction: A Randomized Controlled Trial

Role of Atropine in Attenuating the Side Effects of Propofol in Procedural Sedation in Anterior Shoulder Dislocation Reduction: A Randomized Controlled Trial

Austere Diagnosis and Reduction of Anterior Shoulder Dislocations: 10-Year Review of a Ski Patrol-Based Program with Emergency Medical Technicians

Glenohumeral dislocations present a challenging management dilemma in austere settings where patient transport time may be prolonged. Expeditious reduction is preferable, but treatment is commonly expected to take place within a hospital or comparable facility. Through a novel shoulder injury program, professional ski patrollers trained as emergency medical technicians (EMTs) have diagnosed and reduced anterior shoulder dislocations using biomechanical techniques without sedation or analgesia for over 20 y. Summary records have been maintained to track the performance and safety of this program. Five hundred forty-six records of winter sports-related shoulder injuries from 2009-10 to 2019-20 were retrospectively analyzed to determine the assessment performance and dislocation reduction efficacy of EMTs, with the intent of ascertaining whether EMT-trained practitioners can reliably and safely diagnose and reduce anterior shoulder dislocations without premedication in a remote and resource-limited setting. EMTs identified anterior shoulder dislocations with 98% sensitivity and 96% diagnostic accuracy. The overall success rate of reduction attempts was 86%, or 88% when limited to confirmed anterior dislocations. Two fracture-dislocations and 4 misdiagnoses were manipulated. No instances of iatrogenic harm were identified, and no patients who underwent successful reductions required ambulance transportation. With appropriate education and within a structured program, EMT-trained practitioners can reliably and safely diagnose and reduce anterior shoulder dislocations using biomechanical techniques without premedication in remote and resource-limited environments. Implementation of similar programs in austere settings has the potential to improve patient care. Further, using biomechanical reduction techniques may reduce reliance on procedural sedation irrespective of care setting.

Orthopaedic surgery as seen by artists and by surgeons: science or art?

Artists, including painters, are interested in capturing the essence of the world around them, including surgery. Therefore, we explored the world of orthopaedic surgery through the eyes of artists. We asked how artists and painters have captured the artistic vision of orthopaedic surgery by describing the operation, tools and techniques used, and the patients and surgeons involved. The evolution of medical science and the importance of an orthopaedic surgeon art in society during different centuries were evaluated from ancient civilizations to the modern world. The symbolic representation of orthopaedic surgery and orthopaedic surgeons was analyzed over time, to reflect changes in medical practice and societal attitudes towards orthopaedic surgery. Ancient Egypt is where the first instances of painting a shoulder dislocation reduction were discovered. The first report of organized surgical care is found in Homer's epic poem "Iliad," even if executing surgical operations and artistic representation was undoubtedly done in many ancient civilizations. Orthopaedic surgeons according to the period were represented as gods, saints, monks, heroic figures, military surgeons, and sometimes politics. However, the orthopaedic surgeon was rarely considered an artist by those who are real artists. Paintings often showed orthopedists in action, with blood and tools, emphasizing the gritty reality of the surgical profession, sometimes with some stereotypes (gargantuan figure, gorilla). However, the common thread is the recognition of the skill, knowledge, and dedication required to be a surgeon and the importance of their work in helping people live healthier and more active lives. Overall, painters have depicted orthopedic surgeons as skilled professionals who are dedicated to helping their patients achieve better health and mobility. Their depictions have evolved over time, reflecting changes in medical practice and the wider culture. However, the essential message remains the same: orthopaedic surgeons play a vital role in helping people live healthier, more active lives.

Successful Glenohumeral Shoulder Reduction With Combined Suprascapular and Axillary Nerve Block

BackgroundAnterior glenohumeral dislocation is a common injury seen in the emergency department (ED) that sometimes requires procedural sedation for manual reduction. When compared with procedural sedation for dislocation reductions, peripheral nerve blocks provide similar patient satisfaction scores but have shorter ED length of stays. In this case report, we describe the first addition of an ultrasound-guided axillary nerve block to a suprascapular nerve block for reduction of an anterior shoulder dislocation in the ED. Case ReportA 34-year-old man presented to the ED with an acute left shoulder dislocation. The patient was a fit rock climber with developed muscular build and tone. An attempt to reduce the shoulder with peripheral analgesia was unsuccessful. A combined suprascapular and axillary nerve block was performed with 0.5% bupivacaine, allowing appropriate relaxation of the patient's musculature while providing excellent pain control. The shoulder was then successfully reduced without procedural sedation. Why Should an Emergency Physician Be Aware of This?Procedural sedation for reduction of anterior shoulder dislocations is time consuming, resource intensive, and can be risky in some populations. The addition of an axillary nerve block to a suprascapular nerve block allows for more complete muscle relaxation to successfully reduce a shoulder dislocation without procedural sedation.

Reduction of Shoulder Dislocation using Osteopathic Techniques without Anesthesia, A New Approach

Reduction of Shoulder Dislocation using Osteopathic Techniques without Anesthesia, A New Approach

The size of the Hill Sachs defect increases during reduction of a first time shoulder dislocation in older adults: a pilot study in 20 cases

PurposeTo evaluate if the size of Humeral Hill-Sachs Defects (HSDs) increases during reduction in the emergency department (ED) in subjects that have a first-time anterior shoulder dislocation.MethodsSubjects more than 18 years old presenting to the ED a first-time anterior shoulder dislocation were included. A computed tomography was performed prior to any reduction attempt (Pre-CT). The shoulder was reduced in the emergency room with intraarticular lidocaine; if two attempts failed, the shoulder was reduced under anaesthesia. A second CT was performed after reduction of the shoulder (Post-CT).CT were evaluated using the Osirix software. A 3-dimensional reconstruction of the humeral head was performed and the maximum width of the humeral defect, maximum depth of the humeral defect and total volume of the humeral defect were measured. The relative increase in size was calculated.ResultsTwenty subjects were included in the study. All subjects presented HSDs in the Pre-CT that had a width of a median of 9.9(interquartile range:2.9)mm, a depth of 7.0(3.0]mm and a volume of 355(333)mm2. The HSD in the Post-CT had a width of 10.9(3.0)mm (an increase of 7.23[8.5]%, significant differences, p = 0.0001) a depth of 7.2(2.7)mm (an increase of 9.93[20.7]%, significant differences, p < 0.0001) and a volume of 469(271) mm2 (an increase of 27.5[26.9]%, significant differences, p < 0.0001). There were size increases larger than 25% in 15/20 (75%) of subjects.ConclusionStandard reduction manoeuvres performed in a first-time anterior shoulder dislocation increase the size of the HSD. This increase in size is larger than 25% in four out of five cases.Level of evidenceIV, prospective cases series study.

Comparison of intra-articular lidocaine and intravenous sedation for reduction of shoulder dislocations

Comparison of intra-articular lidocaine and intravenous sedation for reduction of shoulder dislocations

ОРГАНИЗАЦИОННЫЕ И ТЕХНОЛОГИЧЕСКИЕ ОСОБЕННОСТИ ПРИ ЛЕЧЕНИИ ПАЦИЕНТОВ С ВЫВИХОМ ПЛЕЧА (ОБЗОР ЛИТЕРАТУРЫ)

Introduction. Shoulder dislocation currently continues to be the most common among dislocations of all localizations - about 45%. Over the years of observation, this indicator has been decreasing in different countries. More than 50 methods of correcting shoulder dislocation have been described. Methods of correction and organizational features of the treatment of injured are the subject of discussions on scientific forums and on the pages of specialized magazines. The review is dedicated to the analysis of organizational and technological features shoulder dislocation. Results. The existing methods of correcting shoulder dislocation can be divided into three groups: lever; physiological methods based on muscle stretching (traction); methods involving pushing the head of the humerus into the joint cavity (push methods). Despite the many ways, the recurrence shoulder dislocation is noted in almost every second victim. Most often, relapse is stated by young patients. Many specialists note the shortcomings of the methods of correcting the primary traumatic shoulder dislocation as in terms of the choice of the method of correction, and in terms of the organization of the therapeutic and diagnostic process. Among the complications of shoulder dislocation reduction, instability of the shoulder joint, habitual dislocation, restriction of shoulder movement are most often verified. The review analyzes the main methods of conservative correction of shoulder dislocation, provides data on the frequency and structure of complications. Separately, information about anesthesia for the reduction of shoulder dislocation is noted. The features of treatment of injured with shoulder dislocation in outpatient conditions and during hospitalization are shown. Presented overview the literature allows you to orientate yourself in the state of the issue of conservative correction of shoulder dislocation today.

Frequency of recurrent dislocation after conservative management of acute traumatic shoulder dislocation

Dislocations of the shoulder are a serious and expensive issue. Younger males are more likely than older men to experience shoulder dislocations, with overall incidence rates ranging between 23.91 and 23.12 per 100,000 person/years. After initial closure reduction and sling immobilization of the traumatic anterior shoulder dislocation, this study will give us the most recent and accurate information about the severity of recurrence of dislocation. Aim: The goal is to determine the frequency of recurrent shoulder dislocation occurs following conservative treatment. Place and Duration: In the Orthopaedics Department, Khyber Teaching Hospital, Peshawar for six months duration from 28/6/2012 to 28/12/2018. Methods: A total of 172 patients were observed during this study. All patients had conservative treatment, which included manual shoulder reduction and three weeks of immobilization with a sling. In order to reduce bias, all treatments were carried out by a consultant orthopedic surgeon with at least seven years of experience, assisted by a senior postgraduate resident. To check for the recurrence of the dislocation, all patients were instructed to maintain regular follow-up for the following three months.

Study protocol: hypnosis versus standard care for shoulder dislocation reduction in the emergency department – a multicentre, randomised, controlled study protocol

IntroductionAnterior shoulder dislocation is a common reason for consultation at the emergency department (ED). Hypnosis could be a safe and effective alternative therapy for pain relief during shoulder dislocation reduction...

INTRA-ARTICULAR LIGNOCAINE AS ANALGESIA DURING MANUAL REDUCTION OF ACUTE ANTERIOR SHOULDER DISLOCATION: AN OBSERVATIONAL STUDY.

Background:Acute anterior shoulder dislocation needs prompt reduction to provide pain relief. The ideal reduction method should be simple, fast, effective and non- traumatic, with minimal pain, and should not cause further injury to the affected shoulder. Intra-articular lignocaine has been advocated as a means of providing analgesia and subsequent relaxation to the patient.Aim: To assess the efciency of intraarticular lignocaine for reduction of anterior shoulder dislocations. Patients s &amp; Methods: Thirty cases of acute anterior shoulder dislocation were reduced using intraarticular local lignocaine injection as a method of analgesia by Rockwood's traction and counter traction method. Ten to Fifteen ml of 1% lignocaine was injected into the glenohumeral joint through a 20 gauge, 35-mm needle. Approximately ten to fteen minutes were allowed for the local anaesthetic to take effect before any manipulation of the shoulder was attempted. Results: The mean age was 37.2years±18.23 SD with majority of patients in age group of 20 to 40 years. 80% of patients were females. Among thirty patients studied 28 (93.3 %) had primary dislocation and in 18 patients (60 %) dominant shoulder was dislocated. Majority of the dislocations were reduced within 6 hours of injury. Pain assessed through application of a Visual Analog Scale during the maneuver revealed scores ranging from two to eight with mean score of 4.39 ± 1.46 SD (p value 0.049). Conclusion: We conclude method is not only safe and effective but also reduces hospital stay and has negligible adverse effects making it a popular choice for most orthopedists.