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How To Reduce Anterior Shoulder Dislocations Using the Stimson Technique
Step by Step Description of the Stimson Technique
Neurovascular examination Do a pre-procedure neurovascular examination of the affected arm, and repeat the examination after each reduction attempt. Generally, testing motor function is more reliable than testing sensation, partly because cutaneous nerve territories may overlap. Assess the following: Distal pulses, capillary refill, cool extremity (axillary artery) Light touch sensation of the lateral aspect of the upper arm (axillary nerve), thenar and hypothenar eminences (median and ulnar nerves), and dorsum of the 1st web space (radial nerve) Shoulder abduction against resistance, while feeling the deltoid muscle for contraction (axillary nerve): However, if this test worsens the patient's pain, omit it until after the shoulder has been reduced. Thumb-index finger apposition ("OK" gesture) and finger flexion against resistance (median nerve) Finger abduction against resistance (ulnar nerve) Wrist and finger extension against resistance (radial nerve) Intra-articular analgesia The needle insertion site is about 2 cm inferior to the lateral edge of the acromion process (into the depression created by the absence of the humeral head). Swab the area with antiseptic solution, and allow the antiseptic solution to dry for at least 1 minute. Optional: Place a skin wheal of local anesthetic (≤1 mL) at the site. Insert the intra-articular needle perpendicular to the skin, apply back pressure on the syringe plunger, and advance the needle medially and slightly inferiorly about 2 cm. If any blood is aspirated from the joint,hold the needle hub motionless, switch to an empty syringe, aspirate all of the blood, and re-attach the anesthetic syringe. Inject 10 to 20 mL of anesthetic solution (eg, 1%lidocaine). Wait for analgesia to occur (up to 15 to 20 minutes) before proceeding. Reduce the shoulder — Stimson method With the patient prone and secured to the bed, hang the weights from the wrist. The weights may be added gradually rather than all at once, if necessary, to minimize the patient's discomfort. After up to 30 minutes, the muscle spasm usually relaxes enough to allow the humeral head to reduce. If reduction does not occur, manually add some downward traction or apply gentle external rotation to the upper arm. If reduction does not occur, do How To Reduce Anterior Shoulder Dislocations Using Scapular Manipulation with the weights still in place. 