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How To Reduce Anterior Shoulder Dislocations Using the Davos Technique
Step by Step Description of the Davos 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 If a cooperative patient chooses to, try the Davos reduction method without analgesia; however, only one such attempt should be made. To give 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 — Davos method Have the patient come to a sitting position on the flat stretcher and maximally flex the hip and knee of the affected side. Place the patient's elbows on the sides of the thigh, and with the palms facing each other, tightly wrap the wrists together (anterior to the tibial tuberosity) using an elastic bandage. Sit sideways on the stretcher, on top of the foot of the flexed leg. Instruct the patient to relax, gradually lean backward with the spine straight, extend the head, shrug the shoulders, and straighten the relaxed arms. Leaning backward applies traction to the shoulder, with countertraction supplied by the patient's bound wrists around the tibia. The patient adjusts the amount of traction to maintain relaxation and tolerable pain levels. Signs of a successful reduction may include a lengthening of the arm, a perceptible “clunk,” and brief deltoid fasciculation. 