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How To Reduce Anterior Shoulder Dislocations Using Scapular Manipulation
Contraindications to Scapular Manipulation
Contraindications to simple closed reduction: Greater tuberosity fracture with>1 cm displacement Significant Hill-Sachs deformity (≥20% humeral head deformity due to impaction against glenoid rim) Surgical neck fracture (below the greater and lesser tuberosities) Bankart fracture (anteroinferior glenoid rim) involving a bone fragment of over 20% and with glenohumeral instability Proximal Humeral Fractures of 2 or more parts These significant associated fractures require orthopedic evaluation and management, because of the risk of the procedure itself increasing displacement and injury severity. Other reasons to consult with an orthopedic surgeon prior to reduction include The joint is exposed (ie, an open dislocation) The patient is a child, in whom a physeal (growth plate) fracture is often present; however, if a neurovascular deficit is present, reduction should be done immediately if the orthopedic surgeon is unavailable. The dislocation is older than 7 to 10 days, due to an increased risk of damaging the axillary artery during the reduction, especially in older patients 