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ABSTRACT: In a 15-month period, 26 patients with 31 anterior dislocations of the shoulder were seen. A modified Kocher maneuver was first attempted without the use of analgesics or muscle relaxants. This was successful 19 of 31 times (61%). With use of analgesics or muscle relaxants, 30 of 31 (97%) were successfully reduced without complications or fractures with use of this maneuver. In those dislocations seen within 24 hours, without fracture of the greater tuberosity or without failed prior surgery, the modified Kocher maneuver was successful without premedication in 19 of 24 (79%). One patient required general anesthesia.
Introduction
Anterior dislocations of the shoulder are the most common dislocation of a major joint. Many different techniques have been described to attain reduction.1 Among those reported are the Hippocratic, simple traction, traction countertraction, traction with lateral traction, Stimson technique, Milch technique, and the Kocher maneuver. There is controversy regarding the safety of the Kocher maneuver. DePalma2 and others believe that damage to the soft tissues, vessels and brachial plexus, as well as fracture of the humerus or glenoid can result from this technique. This study was undertaken to determine the efficacy and possible complications of a modified Kocher maneuver on acute dislocations of the shoulder. Kocher reported his technique in 1870 after studies on cadavers.3 Moseley states it was described earlier in the nineteenth century by Jacour of France.4 The original Kocher maneuver consists of humeral traction with external rotation, adduction of the arm, and internal rotation . The modification used in the series was obtaining maximal external rotation and abduction to 90°.
Methods
Routine radiographs were obtained in every case. Included were anterior-posterior, axillary and lateral views of the scapula. A physical examination was performed to determine the neurovascular status of the upper extremity.
The reduction was performed in as quiet an atmosphere as could be obtained in a busy emergency room. The reduction was first attempted without the use of premedication with analgesics, muscle relaxants or sedatives. The patient was encouraged to relax and breathe slowly and deeply.
The reduction was performed with the patient supine. If the...