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Scapula Manipulation Technique

scapular manipulationYou can also view a video demonstration of this technique.

Method

This technique fixes the humeral head in position and then rotates the scapula around the head into position.

How does it overcome the static and dynamic forces?

Constant traction is applied to the externally rotated humerus, this takes humeral head pressure off the glenoid rim (which is sitting above and lateral to the dislocated head). The inferior tip of the scapula is then rotated bringing the scapular neck and glenoid fossa back into position.
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Step 1 – Positioning

Where do I start?

The starting point for this is with the arm in 90° of forward flexion and externally rotated (providing the largest surface area of humeral head articular cartilage to the glenoid rim)

Sit your patient with the shoulder externally rotated and in 90° forward flexion
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Step 2 – Apply GENTLE traction

Steady GENTLE traction on the forearm is maintained (5 -15 lbs) until your patient relaxes. Rest on the clavicle to steady the arm (and yourself).
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Step 3 – Rotate the scapula

After the patient begins to relax, rotate the scapula:

Inferior tip – push medially

Superior scapula – push laterally

Remember the scapula!

Again, the position of the scapula in relation to the humeral head is the key.

This technique was originally described in 1979 (Bosley) with the patient prone, this is often impossible with elderly, obese or distressed patients. Two operators and a seated patient is probably the easiest option but prone (with weights giving traction) or supine are alternatives.

Don’t pull!

There is a big difference between steady maintained traction and repetitive yanking which will just cause pain, spasm and failure of your relocation attempt.
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