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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:
What is the best position for my patient?
|Your patient may be ADDUCTED like this…||OR||Your patient may be ABDUCTED like this.|
|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.