How is shoulder dislocation reduced by manipulation?

Our interosseous parts, and the joints connected to the arms, are the parts most prone to dislocation in life. If a shoulder dislocation occurs, most cases can be repositioned through manipulation. Manual reduction also includes other types, such as Koch hair removal, traction massage, etc.

1. Manual reduction

After dislocation, reduction should be performed as soon as possible, and appropriate anesthesia (brachial plexus anesthesia or general anesthesia) should be selected to relax the muscles and allow reduction to be performed painlessly. The elderly or those with weak muscles can also undergo the treatment under the administration of analgesics (such as 75-100 mg of pethidine). Habitual dislocation does not require anesthesia. The reduction technique should be gentle, and rough techniques are prohibited to avoid additional injuries such as fractures or nerve damage. There are three commonly used resetting techniques.

(1) Kocher's method

This method is easier to succeed when the muscles are relaxed. Do not use excessive force to prevent the humeral neck from being subjected to excessive torsional force and causing fractures. Technique steps: Hold the wrist with one hand, bend the elbow to 90 degrees to relax the biceps, hold the elbow with the other hand, continue to pull, slightly abduct, gradually rotate the upper arm outward, then adduct so that the elbow is along the midline of the chest wall, and then internally rotate the upper arm, now it can be repositioned. And noises can be heard.

(2) Traction massage

The injured person lies on his back, one assistant covers the chest with a sheet and pulls it toward the healthy side, the second assistant covers the affected limb with a sheet through the armpit and pulls it outward and upward, the third assistant holds the wrist of the affected limb, pulls it downward and rotates it outward and adducts it inward, and the three assistants pull slowly and continuously at the same time. The surgeon uses his hand under the armpit to push the humeral head outward and reduce it into position. Two people can also do traction reduction.

(3) Hippocrate's method

The patient lies on his back, the surgeon is on the affected side, holds the wrist of the affected limb with both hands, places the heel in the armpit of the affected side, and uses steady and continuous traction with both hands, pushing the humeral head outward with the heel while rotating and adducting the upper arm to reduce the position. A sound can be heard when resetting.

After reduction, the shoulder returns to its normal blunt, round and plump shape, and the dislocated humeral head can no longer be felt in the axilla, under the coracoid process or under the clavicle. The shoulder test becomes negative, and X-ray examination shows that the humeral head is in the normal position. If combined with an avulsion fracture of the greater tuberosity of the humerus, since the fracture fragment is often connected to the humeral shaft by periosteum, in most cases, the avulsed greater tuberosity bone fragment will be reduced after the shoulder dislocation is reduced.

Post-reduction treatment: After reduction of anterior shoulder dislocation, the affected limb should be kept in the adducted and internally rotated position, with a cotton pad placed in the armpit and then fixed to the chest with a triangular bandage, bandage or plaster. After 3 weeks, the shoulder can be gradually swung and rotated, but excessive abduction and external rotation should be avoided to prevent re-dislocation. After reduction, a posterior dislocation is fixed in the opposite position (i.e., abduction, external rotation, and posterior extension).