Analgesic Position 1
For patients presenting in ADDUCTION
The analgesic position is achieved by the following steps.
(1) Bring the humerus to full adduction, (2) flex the elbow, (3) provide gentle continuous axial (down the length of the humerus) pressure, (4) wait, and then ask if your patient is more comfortable. Note this is also the starting position for the Cunningham and Kocher’s methods. See below for further explanation.
| Step 1: Sit your patient up (without slouching). |  |
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| Step 2: The affected arm is adducted (next to the body) and the elbow fully flexed. This optimally shortens the biceps muscle, allowing full relaxation. The humerus points directly down and should be in a neutral position (no forward flexion or external rotation).
Ask the patient to shrug their shoulders, this “squares off” the angle of the shoulder, reducing scapular anteversion and so reducing the static obstruction of the glenoid rim. |
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| Step 3: Kneel next to your patient and place your wrist onto their forearm, with their hand resting on your shoulder.
Wait, and then ask if your patient is more comfortable. Avoid externally rotating the humerus too much – this can hurt. |
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Latest 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!”.
Have you ever wanted to teach your patients how to relocate thier own shoulders? Well now you can! The Boss-Holzach-Matter technique is an autoreduction technique that you can teach your patient to do, directly in the Emergency Department. This simple-to-teach technique also has a patient handout that you can print out.
