Double traction method: Shoulder dislocation

Introduction

In the emergency department, anterior shoulder dislocation is the most common joint dislocation seen. It has been known for more than 2,500 years. Approximately half of all joint dislocations occur in the shoulder, and 90–95% of these are anterior dislocations.

Several methods of closed reduction have been defined, and each physician uses their favored reduction methods; however, most of the classical techniques are associated with discomfort for the patient and iatrogenic injuries.

The most common complications are fracture of the proximal humerus and injury of the plexus brachialis, axillary nerve, and artery. It is painful and difficult for the patient to slacken the strength of their arm during the procedure. Furthermore, emergency physicians may encounter difficulties in reducing some dislocations, and these cases are referred to orthopedic surgeons. Emergency physicians also need to consider inducing iatrogenic fractures during the reduction. Here we will report 70 cases of anterior shoulder dislocations treated with a new simple reduction method for emergency physicians, called the “double traction method”.

Reducing Techniques

Anteroposterior and scapula‐Y view shoulder X‐rays are taken to confirm the direction of dislocation and accompanied fracture. Neurovascular examination is carried out prior to reduction. The reduction is carried out by two operators, with the patient in a supine position (Fig. ). Both operators stand on the side of the dislocated shoulder, and the first operator holds the patient's wrist and pulls gently but strongly longitudinally, approximately 30° abducted from the shoulder joint. Use a sheet wrapped around the patient's chest for counteraction, if necessary. The second operator prepares to tow the humerus head laterally by using a towel wrapped around the proximal arm. After the patient's muscle spasm subsides to an acceptable level, the second operator gently pulls the towel laterally. Video footage demonstrating reductions are provided as supporting information (Movies 1 and 2; Movie 3 shows fluoroscopic view). Use of i.v. sedatives...