• January

    27

    2021
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Reducing Shoulder Dislocation without Anesthesia or Force

One of the most commonly dislocated joints in the human body is the shoulder joint. In most cases say about 25% may also have related fractures as well. The fist treatment approach in shoulder dislocation is reduction. This is the process that involves shifting the shoulder joint back into its position. This is not something that can be attempted by self or at home, a medical professional has to be consulted for this. Several reduction techniques are now used based on the nature of the dislocation. Some among these will require medication or assistance and some others can be performed without the use of force or without administering anesthesia. Around 10 to 15 minutes time is what most reduction techniques take.

Pain relief is almost immediate once the reduction is done and the shoulder is back in its place. In patients aged 20 or younger, there is a 70 to 90 percent possibility for a shoulder dislocation to recur if the treatment recommendations are not properly followed after a reduction. One of the widely used initial treatment for shoulder dislocation happens to be closed reduction but this again will require sedation for the muscles surrounding the shoulder to relax.

Dr. Henry Milch had put forth the Milch method of reduction in 1938 that was especially quite effective in the case of acute anterior shoulder dislocations consisting of shoulder abduction and external rotation with “pulsion” of the humeral head. This gentle technique was comparatively painless and was performed without the help of administering anesthesia. As a first line of treatment this method was also helpful in treating those dislocations that had fracture of the greater tuberosity. This reduction technique can be performed without assistance as well in the dislocation of the glenohumeral joint which is a very common injury.

In the Milch method, the patient lies supine while the doctor slowly pulls the arm first to a 90° abduction, followed by a slow external rotation to 90°. This reduction technique does not require much force because the position lines up the muscles, shoulder blade, and trunk to allow the humeral head to slide back into the shoulder socket. Following this technique, no complications such as nerve damage, displacement of bone fracture, new fracture, or injury to the blood vessels were found to arise.

There are a number of reduction techniques to correct anterior shoulder dislocations. The best technique for reduction is ideally the one that can reduce the dislocation the fastest, and with the greatest reduction rate or one that reduces the amount of time the patient is in pain, and also decreases the need for anesthesia or pain medication, and decreases the amount of time spent in an emergency room. Some other reduction techniques are the Kocher, Spaso, Chair, and Matsen’s traction-counter-traction methods. Of these Kocher and Matsen called for much force and the chair method is quite inconvenient with the need of a chair but this may be the fastest technique though. Comparatively the Spaso technique consists of gentle traction, external rotation, and minimal manipulation. The benefits of a reduction technique without sedation will considerably save staff time in the emergency department and rapid patient disposition can also be facilitated.

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