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Cunningham Technique

cunningham techniqueYou can also view a video demonstration of this technique, or read what Graham Walker (of TheCentralLine.org) or Emergency Medicine News have to say about the technique.

Method

How does it work?

This technique uses a combination of positioning and specific massage of the spasming biceps muscle.

How does it overcome the static and dynamic forces?

Static obstruction is overcome by asking the patient to shrug the shoulders superiorly (up) and posteriorly (back) which “squares off” the angle of the shoulder (reducing scapular anteversion).

The dynamic obstruction of the spasming biceps is actively reduced by massaging the muscle at the mid-humeral level.
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Step 1 – Positioning

Where do I start?

The starting point for this is with the arm in the anatomical position (adducted). This can be difficult or impossible in obese patients. Then get the patient comfortable by moving the affected arm into the analgesic position.

Face directly opposite to the patient and kneel next to them – this avoids any external rotation/flexion of the humerus (which happens if you start off too far away from your patient).

This closeness to the patient also means that they are resting their hand on your shoulder, not reaching for it and clutching with the fingers.

With the humerus adducted, the biceps shortened and the operator’s wrist resting on the patient’s forearm, the patient will usually immediately feel more comfortable. The humerus can be gently moved forwards and back in order to find the perfect angle.

Don’t pull, you’ll only get spasm, pain and an uncooperative patient.

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Step 2 – Massage the shoulder muscles

Where do I massage?

Start by gently massaging the trapezius and deltoids (this helps to relax the patient and reassure them that you are not going to do anything painful), move on to gently massaging the biceps at the mid humeral level.

Be patient!

This technique takes as long as it takes for your patient to relax, anything from seconds to minutes.

Take your time positioning the patient (and yourself) comfortably and don’t pull!
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