injuries and poisoning
Shoulder Dislocation
Treatment of a Dislocated Shoulder
Maneuvers to put the joint back in place A sling and swathe to immobilize the joint Treatment of shoulder dislocations consists of putting the joint back in place (reduction). Before this maneuver, people are often given a sedative, strong pain-relievers, and/or an injection of anesthetic into the joint, but they remain conscious. Many techniques, such as the Davos or Hennepin technique, can be done without use of a sedative, but they require time (several minutes) for the affected muscles to relax enough that the shoulder can be reduced. There are several ways to put the shoulder back in place. They include Traction-countertraction:The person is held still while the practitioner pulls the affected arm down and out. The person lies down on an immobile surface. One practitioner pulls on a folded sheet wrapped around the person's chest to hold the person still as another practitioner pulls the affected arm down and out. The technique is called traction-countertraction. External rotation:An example is the Hennepin technique. The practitioner bends the arm at the elbow, then slowly rotates the arm away from the body. The practitioner bends the arm, then slowly rotates the arm away from the body. Shoulder blade (scapular) manipulation:This maneuver can be done with the person sitting up or lying down. The practitioner moves the bottom tip of the shoulder blade toward the spine. An assistant pulls, rotates, and may apply gentle pressure to the arm. Cunningham (massage) technique:The practitioner sits opposite the person and places the person's hand on the practitioner's shoulder. Then the practitioner massages the muscles in the upper arm and shoulder and instructs the person to relax and to shrug the shoulders back, trying to make the shoulder blades touch each other. Massage helps the muscles relax so that the person can slip the shoulder back in place. Davos (autoreduction) technique:The person sits on a bed, bends the knee on the side of the affected shoulder, and puts that foot on the bed. The person clasps the hands in front of the knee with the elbows close to the thigh, and an elastic band is wrapped around the hands, tying them together and to the knee to hold the hands in place. The practitioner then sits on person's foot and instructs the person to lean the head back. By leaning their head back, people put pressure on the dislocated shoulder, which helps put it back in place. Stimson (dangling weights) technique:The person lies on a bed face down with the arm of the dislocated shoulder hanging over the side of a bed. Weights are attached to the person's wrist. After about 30 minutes, the shoulder muscles usually relax enough for the shoulder to move back in place. FARES (fast and reliable) technique:The person lies face up with the elbow extended and arm by the body. The practitioner holds the person's arm by the hand or wrist and slowly moves the arm away from the person's body. At the same time, the practitioner moves the arm up and down in small, slow, up-and-down oscillating movements. This movement helps the muscles relax. After reduction, the joint is immobilized immediately with a sling and swathe. In people over age 40, the sling and swathe is used for less time than in younger people to encourage movement and help prevent complications (for example, frozen shoulder). 