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Relocation

There is no single right or wrong way to relocate a shoulder, and many methods have been described. Some techniques rely on analgesia and anaesthesia, whereas other methods are successful with the provision of no or minimal analgesia.

The best technique depends on your skill and experience, the patient, and your available resources. Of course a good clinical examination is essential before attempted reduction.

Although most people want to jump right in, we suggest you review the Key Points (below) and then look at Analgesic Positions. Alternatively, you can watch video footage of the techniques here.

Links to Relocation Techniques (if you can’t wait)
We describe the CunninghamKocher’sModified MilchScapula Manipulation and Zero Postion. techniques. They all rely upon the relative movements of the humeral head with respect to the glenoid fossa of the scapula. Analgesic Positions Zero Position Kocher’s
Used correctly, these techniques require little or no force. We do not advocate the use of traction-countertraction techniques (such as the Hippocratic Method). Cunningham Modified Milch Scapular Manipulation

Key Relocation Points

Positioning is everything!

♦ Position Correctly

The first step is to determine the correct position for the patient. Once the patient is positioned, you can use your preferred technique.

No Traction

♦ Don’t pull

You’ll just give your patient pain and find yourself fighting their reflex spasm. Traction-countertraction methods are generally harmful to the patients. if you are using a moderate amount of force to relocate a shoulder, then you are probably doing it wrong.

Be Patient

♦ Be patient

Patients relax at different speeds, once they are fully relaxed, reduction is easy.

Address Pain

♦ Address and Reduce Pain

Pain is due to stretching of the joint capsule, compounded by spasm of the muscles moving across the joint which causes even more stretching of the joint. This can be alleviated using analgesic positions which provide gentle support in the opposite direction to the spasming muscles, helping to reduce joint stretching. This brings the humeral head closer to its anatomical position, relieving pain.  This is also a great starting point to allow you to obtain your patient’s trust and attention and to explain what manoeuvres you are about to perform.


Don't Forget The Scapula ♦ Don’t Forget The Scapula!

The position of the glenoid fossa of the scapula is often forgotten during reduction attempts. If the scapula is fully migrated (anteverted) around the chest wall (see below) you will struggle to reduce the shoulder even if you are doing everything else correctly. Use an assistant to fix the scapula if you need to.



Scapula - Fully Retroverted (blue pen) Scapula - Fully Anteverted (red pen)

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