The Boss-Holzach-Matter technique is an autoreduction technique that you can teach your patient to do, directly in the Emergency Department. It was first described by Boss et al in 1993, however, the paper by Ceroni et al in 1997, brought the technique into the mainstream. It is with Dr Ceroni’s kind permission that we feature the description and illustration.
This technique is especially useful for recurrent dislocators, the ones who dislocate with minor activity e.g. when they get dressed or roll over in bed. The last thing they want is to spend 5 hours in the ED waiting for the morphine and midazolam to wear off.
This simple-to-teach technique also has a patient handout that you can print out. Although this technique can be used for traumatic dislocations within the Emergency Department, the patient information sheet is intended for people who suffer recurrent spontaneous shoulder dislocations, particularly from benign activities (e.g. with stretching or dressing). Prior to attempting this method, it is important to understand the principles of shoulder relocation.
Note, the first time the patient attempts this, they should have direct physician supervision.
This technique does not generally require analgesia or sedation.
Pain is usually due to tensing of shoulder muscles (incl. deltoid, biceps, trapezius), and can usually be eliminated by reminding the patient to relax their shoulders. It is worth reviewing the analgesic positions here.
Don’t rush. The process may take up to 10 minutes. This is a long time in the ED!
The patient is asked to sit on a hard surface (e.g. emergency room examination table).
The patient clasps their hands together, and the forearms and wrists are placed around the homolateral knee, which is flexed at 90 degrees, (the patient may need some assistance to keep the hands together – a separate person can do this, or the wrists can be gently tied together with a crepe bandage).
The head of the examination table is lowered slowly, and the patient is asked to lean backward with his or her neck in hyperextension. In this position, they exert increasing anteriorly directed axial traction on the dislocated shoulder.
The patient also must push his or her shoulders (shrug) anteriorly, thus creating a rotational movement of the scapula around a vertical axis. This rotational movement increases the anteversion of the glenoid cavity that appears essential to spontaneous reduction.
For a patient handout, click here.
Illustration and description used with kind permission from Dr Dimitri Ceroni in: Ceroni D, Sadri H, Leuenberger A. Anteroinferior shoulder dislocation: an auto-reduction method without analgesia. J Ortho Trauma 1997; 11(6): 399-404. Original Technique: Boss A, Holzach P, Matter P. Eine neue Selbstrepositionstechnik der frischen, vorderenunteren Schulterluxation. Helv Chir Acta 1993; 60: 263-5.