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Modified Milch Method (front)

modified milch

You can also view a video demonstration of this technique.

Method

As an alternative to the modified Milch method from the back you can work from the front of the patient leaving your right hand free to push the humeral head if needed. As with all techniques, aim to get your patient comfortable before you start, in this case with Analgesic Position 2.

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Step 1 – positioning (operating from the front)


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Step 2 – abduction and external rotation (operating from the front)

This may allow you to perform humeral head manipulation (step 3) with your thumb if your hands are big enough!

When operating from the front an assistant may be employed to fix the scapula.

“Fixing” the humeral head in place with the right hand while abducting the affected limb with the left.
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Step 3 – push humeral head (operating from the front)

Remember the scapula!

The beauty of this technique is that you have a constant reference of scapular position from the patient.

Be flexible, if you find that the scapula is fully anteverted then you know the “zero position” that you are aiming for is 165° overhead and 45° in front. If you can fix your scapula in retroversion then you will only need to lift the arm to approximately 100° abduction.

Don’t pull!

This method was described in 1949 and discussed elevating the arm “with the greatest gentleness.” That’s right – no traction. If you pull during this manoeuvre your patient will feel pain and the reflex spasm will fight against your attempted reduction.
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