September 2011: Patient heal thyself! Teaching patients to reduce their own shoulders.
Patient Heal Thyself!
Have you ever wanted to teach your patients how to relocate their own shoulders? Well now you can!
The Boss-Holzach-Matter technique is an autoreduction technique that you can teach your patient to do, directly in the Emergency Department. For full instructions, click here (with thanks to Dr D Ceroni, who kindly gave permission to use the graphic and technique on our site).
It’s especially useful for recurrent spontaneous dislocators – you know the ones who dislocate with simple things like getting dressed or rolling 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.
X-ray of the month
Want to see an interesting X-ray? This demented lady presented with heart failure, and she had a routine CXR, which shows a pacemaker in situ. What else does it show?
Related Posts
December 2012 – Neil Cunningham talks at ICEM 2012
This year Dr Neil Cunningham gave a talk at the International Conference in Emergency Medicine, held in Dublin, Ireland. The talk was successful and well received, and the powerpoint presentation and talk are available on our Videos page, or on our Youtube channel. Unfortunately, the popularity led our hosting service to believe we had a virus and they shut the Shoulder Dislocation.net website down! After several months, we are pleased to report we are back up and running on a new dedicated server, thanks to Mike Cadogan and the team at Global Medical Education Project (GMEP). Anyway, we hope you enjoy the talk and presentation and look forward to the next year full of exciting updates.
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January 2012 – Relocation troubleshooting
ShoulderDislocation.net has posted two new videos on our YouTube channel and Videos page. These videos are quite a bit different from the others - in that things didn't quite go as smoothly as we would have hoped. In both of these shoulder dislocations the relocation was proving to be a little difficult and might prompt abandonment of the techniques in favour of heavier sedation. The first video shows a patient with in whom the muscle spasm was unable to be overcome with simple positioning and a variety of manoeuvres. She eventually required sedation resulting an a quick reduction In the second video, the patient has a subglenoid dislocation, and the operator tries to get the patient to adduct the arm. Unfortunately this is difficult, so Neil talks the operator through a series of manoeuvres to manipulate the humerus into the correct position, including attempting Zero Position. Eventually the shoulder is relocated.
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This year Dr Neil Cunningham gave a talk at the International Conference in Emergency Medicine, held in Dublin, Ireland. The talk was successful and well received, and the powerpoint presentation and talk are available on our Videos page, or on our Youtube channel.
Unfortunately, the popularity led our hosting service to believe we had a virus and they shut the Shoulder Dislocation.net website down! After several months, we are pleased to report we are back up and running on a new dedicated server, thanks to Mike Cadogan and the team at Global Medical Education Project (GMEP).
Anyway, we hope you enjoy the talk and presentation and look forward to the next year full of exciting updates.
ShoulderDislocation.net has posted two new videos on our YouTube channel and Videos page.
These videos are quite a bit different from the others – in that things didn’t quite go as smoothly as we would have hoped. In both of these shoulder dislocations the relocation was proving to be a little difficult and might prompt abandonment of the techniques in favour of heavier sedation.
The first video shows a patient with in whom the muscle spasm was unable to be overcome with simple positioning and a variety of manoeuvres. She eventually required sedation resulting an a quick reduction
In the second video, the patient has a subglenoid dislocation, and the operator tries to get the patient to adduct the arm. Unfortunately this is difficult, so Neil talks the operator through a series of manoeuvres to manipulate the humerus into the correct position, including attempting Zero Position. Eventually the shoulder is relocated.
This month, Neil Cunningham talks to Scott Weingart from EM-RAP about shoulder dislocation and the various methods of achieving relocation. The podcast is available for subscribers to EM-RAP. Neil focuses particularly on non-analgesic relocation methods, analgesic positioning, and talks about the recent translation of Kocher’s method.
Have you ever been at a footy or rugby match, or on a skifield and seen someone with a dislocated shoulder? Ever wondered whether it is worth trying to relocate the shoulder “in-the-field”, before xrays, analgesia or transfer to a hospital? Have you thought it might be better for the patient if they got their shoulder in sooner rather than later?
This month Gerard Fennessy shares his experiences on a skifield, dealing with in-the-field dislocations. He talks about sedation and analgesia in remote locations, as well as the use of non-traction/countertraction techniques to make the relocation safer for the patient.
Have you ever thought that there must be a perfect position for your patient with a dislocated shoulder? Well, usually there is (and I don’t mean “relocated’, although apparently that is a pretty good position!).
When your patient comes in with a dislocated shoulder, there are several things you can do to give them immediate pain relief. And we are not necessarily talking about morphine or propofol!
This month we look at analgesic positions for your patient – ones that provide near immediate relief of pain, before you can shout “Get a drip in!”.
