Reduction Of Shoulder Dislocation Research Articles

FARES method for reduction without medication of first episode of traumatic anterior shoulder dislocation.

The aim of this study is to demonstrate the efficiency of (FARES) method for reduction of first-episode anterior shoulder dislocation, as well as its safety, reliability, and quick easy reproducibility by inexperienced physicians without any use of medications. This was a prospective study of 28 patients with first episode of anterior shoulder dislocation that underwent closed reduction using FARES method by junior orthopaedic residents without use of any analgesic, muscle relaxant, or anesthesia. Only two attempts of reduction were allowed for each patient. The time needed for reduction was recorded, and the patients were asked to grade their pain according to a visual analog scale from 0 to 10. Reduction was achieved after one attempt in 21 patients (75%) and after two attempts in three additional patients (total 85.7%). The mean time needed for reduction was 62.66seconds, and the mean visual analog scale for pain evaluation was 5.29. FARES method is a fast, reliable, and safe method for reduction of a first episode of anterior shoulder dislocation and can be easily performed by inexperienced physicians and junior residents.

Our experience with the external rotation method in the reduction of anterior dislocation of the shoulder

Background: Dislocations of the shoulder are injuries frequently seen in the emergency department with the anterior type being the most common. Various methods are available in the reduction of these dislocations. The aim of this study was to evaluate the role of the External rotation method (ERM) in the reduction of these dislocations and to compare the results with that of other authors as available in literature. Methods: 45 patients with anterior dislocation of the shoulder who presented between January 2013 to January 2015 reduced by the external rotation method were included in our study. Results: There was a male preponderance seen in our study with the right side being most commonly affected. The most common mode of injury was slip and fall followed by sports injuries. There were 41 primary and 4 cases of recurrent shoulder dislocations. Sub coracoid type was the most common type seen. 3 patients had associated greater tuberosity fractures out of which one patient required fixation with cannulated cancellous screws. The time taken for reduction ranged from 1.5 to 5 mins with most of the cases reduced within 2 minutes. We had a success rate of 93.3% with no complications encountered in our study. Conclusion: We conclude that the ERM is a simple, safe and easily reproducible procedure for the reduction of shoulder dislocations. It does not cause much discomfort to the patient and gives consistent reductions without the risk of iatrogenic complications associated with other methods of reduction.

Size of greater tuberosity fragment: a risk of iatrogenic injury during shoulder dislocation reduction.

Shoulder dislocation with greater tuberosity fractures (GTF) is becoming increasingly common, as is the number of cases of iatrogenic humeral neck fractures (IHNF) during reduction. This study investigated the relationship between size of greater tuberosity fragment and occurrence of IHNF in patients with shoulder dislocation and GTF. A retrospective study was made to identify all patients presenting with shoulder dislocation with GTF between September 2014 and July 2016. There were 74 patients with an average age of 52.4years (range 18-84years) representing 76 cases of shoulder dislocation associated with GTF. Patient age, injury mechanism and location, treatment waiting time, and reduction method were noted. Using conventional anterior-posterior view radiographs, three points were identified as A, B, and C. Distance ratios between AC and AB were calculated, then the resulting ratio was compared to a critical value of 0.4. More iatrogenic fractures occurred in cases where the AC/AB ratio exceeded 0.4. Most (13) occurred during emergency Hippocratic manual reduction. Only five of 18 iatrogenic fractures (27.78%) occurred during surgery while under traction. Women ran a higher risk of iatrogenic fracture than men (female/male ratio 8:1). On average, women were older than men at the time of fracture (59.75years for women vs. 42years for men). A statistically significant relationship exists between size of greater tuberosity fragment and occurrence of iatrogenic humeral neck fractures during the reduction of shoulder dislocation. The larger the greater tuberosity fragment, the higher the incidence of iatrogenic humeral neck fractures. For such fracture dislocations, we recommend open reduction with internal fixation directly and using a Kirschner wire in advance to reinforce the proximal humerus before reduction of the shoulder.

Lidocaine-Midazolam-Fentanyl Combination in Controlling Pain for Reduction of Anterior Shoulder Dislocation; a Randomized Clinical Trial.

Finding a fast-acting compound with minimal side-effects to induce a safe and efficient analgesia with short or medium duration of action is of great interest in the emergency department. The present study has been designed with the aim of comparing the effect of midazolam + fentanyl + lidocaine combination with midazolam + fentanyl + placebo in pain management of anterior shoulder dislocation reduction. The present two-arm parallel double-blind randomized controlled trial was performed on patients who presented to emergency department with anterior shoulder dislocation. Patients were randomly allocated to the 2 treatment groups of midazolam + fentanyl + placebo (double-drug group) and midazolam + fentanyl + intravenous (IV) lidocaine (triple-drug group). Then outcomes such as treatment success rate and side-effects following prescription of drugs were compared between the 2 groups. 100 patients were included in the present study (50 patients in each group; mean age of the studied patients 27.3±8.9 years; 93.0% male). Using the double-drug regimen led to 35 (70%) cases of complete analgesia, while this rate in the triple-drug group was 41 (82%) cases (p=0.16). The calculated number needed to treat was 9 cases. This means that about one in every 9 patients in treatment arm will benefit from the treatment. The most important side-effects observed included dysrhythmia (1 patient in double drug and 1 patient in triple-drug group), apnea (2 patients in each group) and SPO2<90% (2 patients in triple-drug group) (p=0.78). Number needed to harm was 25 cases. In other words, for each 25 patients treated with the triple drug regimen, 1 case of SPO2<90% is observed. Findings of the present study showed that adding IV lidocaine to IV midazolam + fentanyl drug combination does not provide additional analgesia in sedation for anterior shoulder reduction.

Is intra-articular lidocaine injection a safe and effective alternative to intravenous analgesia and sedation for the manual reduction of acute anterior shoulder dislocation?

EVIDENCE-BASED ANSWER Yes. Intra-articular lidocaine has a lower risk of complications (especially hypoxia and apnea) and similar reduction success rates and pain relief with shorter length of stay than intravenous (IV) analgesia with sedation in the closed manual reduction of acute anterior shoulder dislocation in adults (SOR: B, meta-analyses of lower quality RCTs and single RCT).

Lidocaine-Midazolam-Fentanyl Combination in Controlling Pain for Reduction of Anterior Shoulder Dislocation; a Randomized Clinical Trial

Lidocaine-Midazolam-Fentanyl Combination in Controlling Pain for Reduction of Anterior Shoulder Dislocation; a Randomized Clinical Trial

"A New Method for Reduction of Shoulder Dislocations"

"A New Method for Reduction of Shoulder Dislocations"

Comparison of sedative effectiveness of thiopental versus midazolam in reduction of shoulder dislocation.

Various sedative drugs have been proposed to control anxiety and agitation in shoulder dislocation, but none of them has been diagnosed as the best sedative and relaxant agent. The study aimed to compare the sedative effectiveness of thiopental versus midazolam in reduction of shoulder dislocation. A randomized double-blind controlled trail was performed in 80 patients with shoulder dislocation recruited from the emergency department. Ten patients were excluded and 70 patients were enrolled in the study. Case group received intravenous thiopental 2 mg/kg+2 µg/kg fentanyl while control group received intravenous midazolam 0.1 mg/kg+2 µg/kg fentanyl. Number of times, patients and physician's satisfaction, difficulty of procedure, degree of muscle relaxation, time of sedation and complete recovery, number of patients with apnea episode, O2 saturation, patient's pain score and adverse events were all recorded. Muscular tone had significant difference between the two groups (P-value=0.014) and thiopental was more muscle relaxant than midazolam. Replacement of shoulder dislocation in thiopental group was easier than midazolam group (P-value=0.043). There was no need to use multiple methods of reduction in either group. Before drug infusion the mean±SD VAS scores were 8.37±2.21 in the midazolam group (A) and 8.94±1.78 in the thiopental group (B); mean difference 0.57, 95% CI= -0.38 to 1.52. After completion of the procedure, the mean±SD VAS scores in group (A) and (B) were 3.20±1.30 vs. 3.65±1.30; mean difference -0.45, 95% CI= -1.07 to 0.16. Thiopental might be more effective and relaxant than midazolam for reduction of shoulder dislocation.

An evaluation of the relaibility of videos on youtube related to shoulder dislocation reduction methods

An evaluation of the relaibility of videos on youtube related to shoulder dislocation reduction methods

External rotation method for reduction of acute anterior dislocation of shoulder

Introductions: Many different techniques of reduction of acute anterior shoulder dislocation have been described. The aim of this study was to evaluate the effectiveness of external rotation method for reduction of acute anterior shoulder dislocation.&#x0D; Methods: Fifty-one patients with acute anterior shoulder dislocations with or without greater tuberosity fracture were reduced during a period from January 2013 to January 2015. The external rotation method was used as an initial reduction method performed by orthopaedic surgeon on call or residents. Data sheets completed by the orthopaedic surgeon on call or residents were evaluated with regard to the type of dislocation, the effectiveness of the procedure in achieving reduction, the need for premedication, the ease of performing the reduction, and complications, if any.&#x0D; Results: There were 42 male and nine female patients between 18 to 78 years. Among 51 patients, 49 had successful reduction. No premedication was required in 33 patients who had a successful reduction, and the average time required for reduction in 23 patients was within two minutes whereas 20 patients reduced within five minutes. Only four patients reported severe pain during the process of reduction. The method was not successful in two patients with subcoracoid dislocation associated with displaced fracture of the greater tuberosity.&#x0D; Conclusions: External rotation method is reliable, safe, simple and relatively painless method for reduction of acute anterior shoulder dislocation.

Closed reduction of shoulder dislocations in the emergency department: does an emergency medicine residency affect the orthopaedic resident experience?

Background: The shoulder is a mobile joint at risk for dislocation that can lead to presentation to an emergency department (ED). Our objective was to study the impact of establishing an emergency medicine (EM) residency program on the orthopaedic resident experience in management of simple shoulder dislocations (SSD). Methods: A retrospective review of patients presenting to the ED with a diagnosis of an isolated SSD was conducted based on ICD-9/CPT code. The time intervals studied were: 2006-07 (Group 1, pre-EM residency) and 2012-13 (Group 2, post-EM residency). Forty-three patients met inclusion criteria in group 1; 38 patients met the inclusion criteria in group 2. Outcomes studied were reduction attempts and success rates by EM and orthopaedic residents. Results: In Group 1, orthopaedic residents attempted reductions in 37% (16 of 43) of the patients and were 100% successful in the ED. There was a mean of 2.67 reduction attempts per orthopaedic junior resident per year. In group 2, orthopaedics attempted reductions in 29% of the patients (11 of 38). Orthopaedic residents were successful in nine of 11 of ED reductions. There was a mean of 1.57 attempts at shoulder reductions per orthopaedic resident per year. The average number of shoulder reduction attempts per orthopaedic resident was not significantly different between the groups (P=0.566). Conclusions: No significant change in the number of reductions managed by either department was shown, but the discrepancy should be discussed. Orthopaedic residency directors should audit their trainees experience with SSDs and consider collaborating with the EM program to optimize training opportunities.

Comparison of Suprascapular Nerve Block and Procedural Sedation Analgesia with Intravenous Ketamine and Midazolam in Shoulder Dislocation Reduction

Comparison of Suprascapular Nerve Block and Procedural Sedation Analgesia with Intravenous Ketamine and Midazolam in Shoulder Dislocation Reduction

Anesthesia and Analgesia in the Patient with an Unstable Shoulder.

Introduction:The patient with an unstable shoulder represents a challenge for the anesthesiologist. Most patients will be young individuals in good health but both shoulder dislocation reduction, a procedure that is usually performed under specific analgesia in an urgent setting, and instability surgery anesthesia and postoperative management present certain peculiarities.Material and Methods:For the purpose of the article, 78 references including clinical trials and reviews were included. The review was organized considering the patient that presents an acute shoulder dislocation and the patient with chronic shoulder instability that requires surgery. In both cases the aspects like general or regional anesthesia, surgical positions and postoperative pain management were analyzed.Conclusion:The patient with an acutely dislocated shoulder is usually managed in the emergency room. Although reduction without analgesia is often performed in non-medical settings, an appropriate level of analgesia will ease the reduction procedure avoiding further complications. Intravenous analgesia and sedation is considered the gold standard but requires appropriate monitorization and airway control. Intraarticular local analgesic injection is considered also a safe and effective procedure. General anesthesia or nerve blocks can also be considered. The surgical management of the patient with shoulder instability requires a proper anesthetic management. This should start with an exhaustive preoperative evaluation that should be focused in identifying potential respiratory problems that might be complicated by local nerve blocks. Intraoperative management can be challenging, especially for patients operated in beach chair position, for the relationship with problems related to cerebral hypoperfusion, a situation related to hypotension events directly linked to patient positioning. Different nerve blocks will help attaining excellent analgesia both during and after the surgical procedure. An interescalene nerve block should be considered the best technique, but in certain cases, other blocks can be considered.

Nerve Block vs. Sedation for Reduction of Anterior Shoulder Dislocation

For reduction of anterior shoulder dislocations, options include procedural sedation, intraarticular lidocaine injection, nerve block, and manipulation

Irreducible Anterior Shoulder Dislocation with Interposition of the Long Head of the Biceps and Greater Tuberosity Fracture: A Case Report and Review of the Literature

Background:Failure of closed manipulative reduction of an acute anterior shoulder dislocation is seldom reported in the literature and is usually due to structural blocks such as soft tissue entrapment (biceps, subscapularis, labrum), bony fragments (glenoid, greater tuberosity) and severe head impaction (Hill-Sachs lesion).Case report:We present a case of an irreducible anterior shoulder dislocation in a 57-year-old male patient after a road-traffic accident. He had severe impaction of the head underneath glenoid rim and associated fracture of the greater tuberosity. Closed reduction performed in the emergency room under sedation and later at the theatre under general anaesthesia was unsuccessful. Open reduction using the dectopectoral approach revealed that the reason for obstruction was the posterolateral entrapment of the biceps tendon between the humeral head and the tuberosity fragment. Reduction was achieved after subscapularis tenotomy and opening of the joint; the tuberosity fragment was fixed with transosseous sutures and the long head of the biceps tendon was tenodesized. The patient had an uneventful postoperative recovery and at his last follow up, 12 months postoperatively, he had a stable joint, full range of motion and a Constant score of 90.Conclusion:A comprehensive literature review revealed 22 similar reports affecting a total of 30 patients. Interposition of the LHBT alone or in combination with greater tuberosity fracture was the most common obstacle to reduction, followed by subscapularis tendon interposition and other less common reasons. Early surgical intervention with open reduction and confrontation of associated injuries is mandatory for a successful outcome.

Ultrasound-guided interscalene nerve block vs procedural sedation by propofol and fentanyl for anterior shoulder dislocations

BackgroundFew studies were performed to compare ultrasound guided brachial plexus block with procedural sedation for reduction of shoulder dislocations in the Emergency Department (ED). This study was done to provide further evidence regarding this comparison. MethodsThis was a randomized clinical trial performed on patients presenting with anterior shoulder dislocations to the emergency department of an academic level 2 trauma center. Exclusion criteria were any contraindications to the drugs used, any patient which may not be potentially assigned into both groups because of an underlying medical condition, presence of neurovascular compromise related to the dislocation, presence of concomitant fractures, and patient refusal to participate in the study. Patients were randomly assigned into the Procedural Sedation and Analgesia (PSA) group with propofol and fentanyl or ultrasound guided Inter-Scalene Brachial Plexus Block (ISBPB) with lidocaine and epinephrine. ResultsA total of 60 patients (30 in each group) were included in the study. The emergency room length of stay was significantly lower in the ISBPB group, with mean (SD) values of 108.6 (42.1) vs. 80.2 (25.2) minutes (p=0.005). However, pain scores in the PSA group during reduction showed advantage over ISBPB [0.38 vs. 3.43 (p<0.001)]. Moreover, patient satisfaction was higher with PSA (p<0.001). ConclusionUsing ISBPB for reduction of anterior shoulder dislocations takes less time to discharge and may make it more feasible in conditions mandating faster discharge of the patient. However, since pain scores may be lower using PSA, this method may be preferred by many physicians in some other situations.

A systematic comparison of the closed shoulder reduction techniques.

To identify the optimal technique for closed reduction for shoulder instability, based on success rates, reduction time, complication risks, and pain level. A PubMed and EMBASE query was performed, screening all relevant literature of closed reduction techniques mentioning the success rate written in English, Dutch, German, and Arabic. Studies with a fracture dislocation or lacking information on success rates for closed reduction techniques were excluded. We used the modified Coleman Methodology Score (CMS) to assess the quality of included studies and excluded studies with a poor methodological quality (CMS < 50). Finally, a meta-analysis was performed on the data from all studies combined. 2099 studies were screened for their title and abstract, of which 217 studies were screened full-text and finally 13 studies were included. These studies included 9 randomized controlled trials, 2 retrospective comparative studies, and 2 prospective non-randomized comparative studies. A combined analysis revealed that the scapular manipulation is the most successful (97%), fastest (1.75min), and least painful reduction technique (VAS 1,47); the "Fast, Reliable, and Safe" (FARES) method also scores high in terms of successful reduction (92%), reduction time (2.24min), and intra-reduction pain (VAS 1.59); the traction-countertraction technique is highly successful (95%), but slower (6.05min) and more painful (VAS 4.75). For closed reduction of anterior shoulder dislocations, the combined data from the selected studies indicate that scapular manipulation is the most successful and fastest technique, with the shortest mean hospital stay and least pain during reduction. The FARES method seems the best alternative.

A Case of a Successful Bilateral Shoulder Dislocation Reduction Using the Scapular Rotation Method in the Emergency Service

A Case of a Successful Bilateral Shoulder Dislocation Reduction Using the Scapular Rotation Method in the Emergency Service

A comparative study of the Milch method and the Spaso method in the reduction of anterior dislocation of the shoulder

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The Milch and Spaso methods are used for reduction of anterior shoulder dislocation of the shoulder. This study was undertaken to compare the efficacy of these two methods&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Sixty patients with anterior glenohumeral dislocation were included in this study. 30 patients were reduced by each of the 2 methods and the efficacy and the pain experienced by the patient was studied.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Both methods were found to be equally efficacious. The pain felt by the patient was lower in the Milch method but this was not statistically significant&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Both the Milch and the Spaso methods are equally effective methods for reduction of anterior dislocation of the shoulder&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;

Intra-articular lignocaine as a means of analgesia during manual reduction of acute anterior shoulder dislocation

Background &amp; Objectives: Acute anterior shoulder dislocation needs prompt reduction of the dislocation. 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 local lignocaine injection is a means of achieving analgesia with less complication, and allowing prompt patient discharge of patient after reduction. The study was conducted with objective to evaluate the effectiveness of intra-articular lignocaine for reduction of acute anterior shoulder dislocation.Materials &amp; Methods: Twenty- one cases of acute anterior shoulder dislocation were reduced using intra-articular local lignocaine injection as a method of analgesia by modified Hippocrates method.Results: The mean age was 44.71 years ± SD 20.14 while 11 cases were reduced with one to six hours of injury. Pain assessed through application of a visual analogue scale during the maneuver revealed scores ranging from two to eight with mean score of 4.29 ± SD 1.55.Conclusion: This 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.