Analgesic Positions
Adequate positioning is the first step to successfully relocating the shoulder. So-called “analgesic positions” can provide immediate relief of pain, and if successful will be adequate for the majority of patients. There is also a position known as “zero position“, the position at which the muscles that traverse the joint provide least translational forces (pulling to one side or the other).
The ability to obtain an analgesic position is dependent upon several factors:
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What is the best position for my patient?
| Your patient may be ADDUCTED like this… | OR | Your patient may be ABDUCTED like this. |
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| The patient has the affected arm adducted (next to the body), the elbow bent and the wrist supported by the other arm. In most cases they are leaning towards the affected shoulder.
In adduction try Analgesic Position 1. |
The patient has the affected arm hanging down with the arm abducted (away from the body). They may be supporting the elbow in abduction.
In abduction try Analgesic Position 2. |
Now choose your technique!
- Choose your technique based upon the patient’s initial starting position.
If they are comfortable in adduction then use a technique that employs this (Cunningham, Kocher’s). Similarly, if they are starting from a position of abduction and it is painful to adduct, then use an abduction manoeuvre (Modified Milch, Scapular Manipulation).
With any technique, the patient can be supine, seated or prone providing you know the position of the humerus (adducted vs abducted) and the scapula (rotated/anteverted vs retroverted). Remember, we are trying to achieve Zero Position.
Move the affected arm as little as possible while you are reducing a dislocation. If you are unsuccessful with one technique you can always try your second choice method without having to move your patient.
Latest Updates
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!”.
