Reduction Of Shoulder Dislocation Research Articles

Patient Participation Approach to Reduction of Anterior Shoulder Dislocation: P-R-I-M/O-Y-E-S.

A variety of successful techniques are available for reduction of shoulder dislocation; none have been shown to be clearly superior to another. Analgesic methods vary as well from none to deep sedation-analgesia. The literature hints at the importance of optimal muscle relaxation as a factor of success. Yet, the literature describes only cursorily the means by which muscle relaxation is optimized. Patient-centered participation and relaxation methods have been used in other contexts to reduce pain, anxiety, and muscle tension. This article proposes to integrate a patient-centered participation approach to the reduction of anterior shoulder dislocation as a way to optimize muscular relaxation nonpharmacologically. It can be used in the field in combination with the practitioner's reduction technique of choice. It minimizes risks because it entails no deep pharmacological sedation. The mnemonic P-R-I-M/O-Y-E-S is used to respectively represent the four phases: Preparation, Rehearsal, Intervention, and Mobilization as well as the 4 repeated steps in each phase of the procedure: Observe, Yield control, Explain, and Support. The focus is on (1) securing optimal patient participation within a patient-centered approach and (2) achieving nonpharmacological muscular relaxation through a simple relaxation routine. More studies are needed to identify the factors that determine success and guide the practitioner's choice among available options in shoulder dislocation reductions.

Intra-articular lidocaine versus intravenous sedative and analgesic for reduction of anterior shoulder dislocation

ObjectiveThis prospective clinical trial was performed to compare the safety and efficiency of intra-articular lidocaine (IAL) versus intravenous sedative and analgesic (IVSA) in reduction of anterior shoulder dislocation. Materials and methodsPatients with anterior shoulder dislocation were randomly divided into 2 groups to receive IAL and IVSA. One group patients received an intravenous dose of 0.05 mg/kg midazolam and 1 μg/kg fentanyl, while the other group received 20 mL intra-articular lidocaine (1%). Patient satisfaction (via a standard 5-choice questionnaire), pain score (based on visual analog scale ranging from 0 to 10 points), comfort reduction, recovery time, and side effects were recorded and compared between the two groups before, during and after the reduction procedure. ResultsTotally 104 patients with acute anterior shoulder dislocation and the mean age of 28.75 ± 7.24 years were included (86.5% male). There was no statistically significant difference between IAL and IVSA groups regarding age (p = 0.45) and gender (p = 0.25). A total of forty-seven (45.2%) patients, distributed in both groups, had a history of anterior shoulder dislocation. A significant difference was seen with regard to diminished pain intensity during reduction in IAL group (p < 0.001); Complications including nausea, apnea, hypoxia and headache were only observed in IVSA group, and there was no adverse effect in IAL group; increased patient satisfaction in IVSA group (p = 0.007); similar success rate at first attempt of reduction in both groups, and a shorter time to discharge in IAL group (p < 0.001). ConclusionIt seems that the use of intra-articular lidocaine for reduction of anterior shoulder dislocation is effective, safe, and time saving in the emergency department and has few complications. It can be considered as the first line analgesia in managing anterior shoulder dislocation.

Remifentanil versus Fentanyl/Midazolam in Painless Reduction of Anterior Shoulder Dislocation; a Randomized Clinical Trial.

Performance of painful diagnostic and therapeutic procedures is common in emergency department (ED), and procedural sedation and analgesia (PSA) is a fundamental skill for every emergency physician. This study was aim to compare the efficacy ofremifentanil with fentanyl/midazolam in painless reduction of anteriorshoulder dislocation. In this randomized, double blind, clinical trial the procedural characteristics, patients' satisfaction as well as adverse events were compared between fentanyl/midazolam and remifentanil for PSA of 18-64 years old patients, which were presented to ED following anterior shoulder dislocation. 96 cases were randomly allocated to two groups (86.5% male). There were no significant difference between groups regarding baseline characteristics. Remifentanil group had lower duration of procedure (2.5 ± 1.6 versus 4.6 ± 1.8 minutes, p < 0.001), higher pain reduction (53.7 ± 13.3 versus 33.5 ± 19.6, p < 0.001), lower failure rate (1 (2.1%) versus 15 (31.3%), p < 0.001), higher satisfaction (p = 0.005). Adverse events were seen in 12 (25%) patients in midazolam/fentanyl and 8 (16.7%) cases in remifentanil group (p = 0.122). It seems that use of remifentanil resulted in lower procedural time, lower failure rate, and lower pain during procedure as well as higher patient satisfaction in comparison with midazolam/fentanyl combination in anterior shoulder dislocation.

Remifentanil versus Fentanyl/Midazolam in Painless Reduction of Anterior Shoulder Dislocation; a Randomized Clinical Trial

Remifentanil versus Fentanyl/Midazolam in Painless Reduction of Anterior Shoulder Dislocation; a Randomized Clinical Trial

Reduction of acute posterior shoulder dislocation with the FARES method: A case report and a review of the literature

Posterior shoulder dislocation is a rare entity in clinical practice. The FARES (Fast, Reliable, Safe) method is a well-validated, effective, and rapid approach to achieve reduction of anterior shoulder dislocation, but its use for posterior shoulder dislocation has not been reported previously. A 46-year-old man was admitted to our hospital with acute posterior shoulder dislocation due to a fall experienced while inebriated. We used the FARES method to achieve successful reduction of this case of acute posterior shoulder dislocation without general anesthesia.

Iatrogenic Humeral Fracture during Reduction of Shoulder Dislocation: Two Cases Report

Iatrogenic Humeral Fracture during Reduction of Shoulder Dislocation: Two Cases Report

Orthopaedic Tips Closed Reduction of Shoulder Dislocations

Journal of Orthopaedics for Physician Assistants 4(4):p 15-18, Fall 2016. | DOI: 10.2106/JBJS.JOPA.16.00015

Comparison between traction-countertraction and modified scapular manipulation for reduction of shoulder dislocation

ObjectiveOne of the most common joint dislocations presented to the emergency department (ED) is anterior shoulder dislocation (ASD). Various techniques for the treatment of this abnormality have been suggested. In this study, we evaluated the efficacy and success rate of modified scapular manipulation (MSM) as a painless procedure compared to traction-countertraction (TCT) for reduction of ASD. MethodsPatients with ASD who were presented to ED of Baqiyatallah Hospital, Tehran during 2011 were included. They were randomly divided into MSM group or TCT group and then pain at reduction, time of reduction, duration of hospitalization, and success rate were compared. In TCT group, reduction was performed using sedative and antipain medications. ResultsNinety seven patients (81.6% male) with a mean age of 34.15 years±13.48 years were studied. The reduction time between both groups showed a significant difference (470.88 seconds±227.59 seconds for TCT group, 79.35 seconds±82.49 seconds for MSM group, P<0.001). The success rate in MSM group in the first and second effort were 89% and 97% whereas 73% and 100% in the TCT group respectively (P<0.001). ConclusionIt seems that the manipulation technique can be more successful than the TCT method at the first effort whilst the second effort has the opposite results. Also MSM can be safer, cheaper and more acceptable for patients than TCT as a standard traditional method.

Anterior Shoulder Dislocations in Busy Emergency Departments: The External Rotation Without Sedation and Analgesia (ERWOSA) Method May Be the First Choice for Reduction.

Shoulder joint is the most common joint requiring reduction by emergency physicians. Successful reduction is based on the overcoming of resistance of the shoulder muscles. Pain is the most important factor in resistance increase and sedation; analgesia and, in certain cases, intra-articular anesthesia are preferred for reduction. The external rotation (ER) method can provide successful reduction without causing an increase in muscle resistance if applied slowly and gently. The aim of this study was, therefore, to determine the usefulness of the ERWOSA method in the reduction of acute anterior shoulder dislocations (AASDs).This was a retrospective descriptive study. The records of patients admitted to the emergency department with anterior shoulder dislocation between 2009 and 2011 were reviewed for demographic data, sedation, analgesia, and discharge times. Patients were then divided into ERWOSA (n = 80) and external rotation and sedation-analgesia (ERASA, n = 59) groups, with regard to the application of SA (sedation-analgesia). The study data were analyzed using SPSS version 22.0 software for Windows. Numerical data were presented as mean ± standard deviation and categorical data as rates.A total of 139 patients were included in the study. The patients’ average age was 35 ± 14 years, 108 (77.7%) were male. Successful reduction rates for 59 male and 21 female patients in the ERWOSA group were 83% and 66.7% (78.7% total success), respectively. Successful reduction rates for 49 male and 10 female patients in the ERASA group were 87.7% and 90% (88.1% total success), respectively. The length of stay of the ERWOSA and ERASA groups in emergency services were found to be significantly different, with 55 ± 17 and 118 ± 23 minutes for each group, respectively. There were no complications.The ER method can be used in reduction of anterior shoulder dislocations without sedation and analgesia, if applied slowly enough to overcome the resistance of shoulder muscles. The ERWOSA method causes both a significant decrease in the length of stay of patients in the emergency department results in negating the possibility of adverse drug effects. In busy emergency departments, male patients with anterior shoulder dislocation are particularly suitable candidates for ERWOSA.

346 Anterior Shoulder Dislocation Reduction in the Emergency Department: Is There a Best Technique?

346 Anterior Shoulder Dislocation Reduction in the Emergency Department: Is There a Best Technique?

A simple and gentle technique for reduction after anterior shoulder dislocation.

Anterior shoulder dislocation (ASD) is a common sports injury. The goal of this study was to evaluate a new procedure for reduction after ASD with respect to success rate, the need for medication for muscle relaxation, sedation, and application of pain medication and put it into context to a systematic literature review. We retrospectively evaluated the new method in 263 patients in an Austrian skiing area from December 2005 till April 2009. We included patients with unilateral ASD and excluded those with a combined trauma and consecutive admission to hospital. The new procedure is performed in a supine position, the therapist takes the patients hand of the injured limb with his one hand and with his other hand counter holds against the acromion. Then he enhances the traction on the upper limp by using his trunk as a kind of fulcrum. With eye contact and instructions to relax, the therapist is able to detect the muscular tension, so that he can adjust the amount of traction accordingly. The presented procedure was successful in all reported cases. For 196 patients (74.5%) no medication for muscle relaxation, sedation, or pain medication were needed. The new method is a promising option to popular techniques for reduction of anterior shoulder dislocations. The benefits of this protocol are a gentle and simple application of the procedure as well as an easy acquisition.

Delays to initial reduction attempt are associated with higher failure rates in anterior shoulder dislocation: a retrospective analysis of factors affecting reduction failure

IntroductionLittle is understood about the relationship between delay to treatment and initial reduction success for anterior shoulder dislocation. Our study examines whether delays to initial treatment, from injury and hospital...

Reduction of Acute Shoulder Dislocations in a Remote Environment: A Prospective Multicenter Observational Study

Acute dislocations of the glenohumeral joint are common in wilderness activities. Emergent reduction should take place at the site of trauma to reduce the patient's pain and the risk of vascular and neurological complications. A limited number of reduction methods are applicable in remote areas. The aim of this study is to present our method of reduction of anterior shoulder luxation that is easily applicable in remote areas without medication, adjuncts, and assistants and is well tolerated by patients. A prospective observational study was conducted during a 5-year period. The patients included underwent closed manual reduction with our technique. After each reduction, the physician who performed the reduction completed a standardized detailed history, and reexamined the patient (for acute complications). The patients were contacted 6 months after the trauma to investigate long-term postreduction complications. Reduction was achieved with our method in 39 (100.0%) of 39 patients. The mean pain felt during our reduction procedure was rated 1.7 ± 1.4 (on a scale of 10) using the visual analog scale scoring system. No complications were noted before or after the reduction attempts. We did not find any long-term complications. The reduction method presented in the present study is an effective method for the reduction of acute shoulder luxations in remote places. Our data suggest that this method could be applied for safe and effective reduction of shoulder dislocation.

Flexion Adduction External Rotation (FADER) method for reduction of anterior shoulder dislocation: a study of 30 cases

Objective: To assess the success rate of Flexion Adduction External Rotation (FADER) technique in reducing anterior shoulder dislocation and to report our experience. Methods: A prospective study included 30 patient, with 21 male and 9 female associated with acute anterior dislocation of shoulder treated by FADER in a medical college attached hospital. Results: The FADER technique was used to reduce 30 cases of anterior dislocation shoulder during the study period. 27 cases were first time dislocations and 3 cases second time recurrent dislocations. Fracture of greater tuberosity was present in 2 cases. Reduction is achieved in first attempt in 28 cases, in second attempt in 1 case, and 1 case was reduced under general anaesthesia. No complications were noted. Overall success rate was 96.6% Conclusion: we report the successful use of FADER technique for reduction of traumatic anterior shoulder dislocations, mainly without traction, exhaustion, second assistant, anaesthesia, sedation and uncomfortable position. We believe that FADER may also be applied by inexperienced physicians, as it is simple, easily understood and reproducible with success Keywords: Anterior, Shoulder, Dislocation, FADER, Reduction.

Efficacy of the assisted self-reduction technique for acute anterior shoulder dislocation.

The "original" traction-free Kocher's method to perform the reduction of shoulder dislocation has been recently reviewed and some authors speculated that it can be self performed by patients under the guide of the physician. In this way, as an "assisted self-reduction" technique, it is also effective and simple to perform. The aim is to study the effectiveness of the assisted self-reduction technique, in comparison to the well known and largely used traction-countertraction method. From a consecutive series of 237 uncomplicated anterior shoulder dislocations, a total of 61 were managed by the residents of our institution under the supervision of the senior authors using the assisted self-reduction method and 176 were managed by other orthopaedic consultants on duty in the Emergency Department using the traction-countertraction technique. Only the senior authors used the assisted self-reduction technique, whereas the other orthopaedic consultants used the traction-countertraction method. The need for intravenous sedation or general anaesthesia to perform the assisted self-reduction was considered a failure. Recorded variables were demographic data, previous dislocation, traumatic mechanism and medication use during shoulder reduction, time to perform the reduction. Ninety-eight percent of the acute dislocation treated with the assisted self-reduction technique and 81 % treated with the traction-countertraction method were reducible without recourse to intravenous sedation. The assisted self-reduction technique is simple, effective and gentle. Physicians on duty in the Emergency Departments should therefore be encouraged to use it.

Anterior Shoulder Dislocation Reduction Managed Either with Midazolam or Propofol in Combination with Fentanyl

Objective Procedural Sedation and Analgesia is used in managing emergency painful procedures. The aim of this study is to compare the effects of propofol and midazolam on haemodynamic parameters when used in combination with fentanyl in isolated anterior shoulder dislocations and to measure the patient and physician satisfactions. Methods The study is a randomised single blind prospective trial. All procedural sedations were performed by emergency medicine specialists and the shoulder reductions were performed by orthopaedic surgeons. Two groups were defined. Group A received intravenous fentanyl and midazolam and Group B received intravenous fentanyl and propofol. The orthopaedic surgeons were not informed about the drugs. The emergency medicine specialist observed the patients. The patients and the orthopaedic surgeons were asked for a satisfaction scoring. Results Midazolam group consisted of 37 patients and propofol group consisted of 38 patients. Both groups were similar in demographic characteristics and pre-procedural vital signs. There was only one statistically significant difference at one time and it was the 5th minutes SpO2 levels between groups. There were statistically significant changes in the measurements of vital parameters in both groups when compared with the baseline levels. However none of them was clinically important. In midazolam and propofol group, 10.8% and 10.5% respectively had respiratory compromise. Patient and physician satisfactions were similar in both groups. Conclusions Midazolam and propofol are both relatively safe drugs using in combination with fentanyl in anterior shoulder dislocations. Patients and physicians can be highly satisfied with the two groups of drugs. (Hong Kong j.emerg.med. 2014;21:346-353)

Modified Milch Technique : A Safe and Painless Method for Reduction of Anterior Shoulder Dislocation

Background: The shoulder is the most commonly dislocated major joint in the body and this dislocation causes severe and agonizing pain. Prompt and painless reduction forms the cornerstone of treatment. We studied the efficacy of the Milch technique in the reduction of anterior dislocation of shoulder. Materials: Between September 2011 and March 2014, 60 cases of anterior dislocation of shoulder were reduced by Milch technique in C.S Hospital Shivamogga and Dhruva Orthopaedic Clinic Shivamogga and the pain experienced by the patient was quantified by Visual Analogue Score. Results: Reduction was successful in 56 cases (93.3%). The mean Visual Analogue score was 1.82. There were no complications. Conclusion: We conclude that the Milch technique is a very effective and relatively painless method for reducing anterior dislocation of the shoulder.

Is there randomized controlled trial evidence to support the use of intra-articular lidocaine instead of intravenous analgesia for manual reduction of acute anterior shoulder dislocation?

Is there randomized controlled trial evidence to support the use of intra-articular lidocaine instead of intravenous analgesia for manual reduction of acute anterior shoulder dislocation?

Intra-articular lidocaine versus intravenous analgesia and sedation for manual closed reduction of acute anterior shoulder dislocation: an updated meta-analysis

Study ObjectiveTo compare intra-articular lidocaine (IAL) with intravenous analgesia and sedation (IVAS) for manual closed reduction of acute anterior shoulder dislocation. DesignMeta-analysis. SettingMetropolitan medical university. MeasurementsA literature search was conducted of PubMed, Ovid and Cochrane Library, to identify randomized controlled trials (RCTs) published from January 1, 1990 to September 1, 2012, that compared IAL with IVAS for manual closed reduction of acute anterior shoulder dislocation. Effective data were pooled using fixed-effects or random-effects models with mean differences (MDs) and risk ratios (RRs) for continuous and dichotomous variables, respectively. Main ResultsNine RCTs comprising 438 patients were analyzed. Statistical analyses showed that IAL was superior to IVAS with respect to lower complication risk (P < 0.00001) and shorter mean hospital length of stay (P = 0.03). No significant differences were noted in success of joint reduction (P = 0.16), patient satisfaction (P = 0.12), or postreduction pain relief (P = 0.76). However, IAL required more time than IVAS from injection to reduction (P < 0.00001). Subgroup analyses showed that IVAS was associated with higher risks of respiratory depression (P < 0.0001), vomiting (P = 0.04), and thrombophlebitis (P = 0.008), but no statistical differences were identified in nausea (P = 0.06), hypotension (P = 0.10), drowsiness (P = 0.45), or headache (P = 0.29). ConclusionsIntra-articular lidocaine injection may be safer than IVAS because there are fewer risks of postoperative complications with IAL. Both techniques are similarly effective for manual closed reduction of acute anterior shoulder dislocation.

Intra-articular Lidocaine for Reduction of Shoulder Dislocation

Pediatric Emergency Care: May 2014 - Volume 30 - Issue 5 - p 363-365 doi: 10.1097/01.pec.0000449812.06097.b8