Reduction of anterior shoulder dislocations by scapular manipulation

STUDY OBJECTIVES: This study examined the success rate, time required, technical ease, and reported patient discomfort for the use of scapular manipulation in the reduction of anterior shoulder dislocation. This study included a new variation of this technique using the seated position.

DESIGN: Prospective case series over a 19-month period.

SETTING: The emergency departments of a university and a community hospital.

TYPE OF PARTICIPANTS: Patients with anterior shoulder dislocations.

INTERVENTIONS: Emergency medicine resident and attending physicians were instructed in the technique of scapular manipulation in a classroom setting and requested to use this method initially for the reduction of anterior shoulder dislocations. Premedication was at the physician's discretion.

MEASUREMENTS AND MAIN RESULTS: There were 54 patients with 61 dislocations. Scapular manipulation was attempted by 19 residents and 12 attending physicians. The overall success rate of scapular manipulation was 79%, whereas that of physicians experienced with the technique was 86%. Of the successful reductions, 65% were performed in less than one minute, and physicians rated the technique as very easy or easy to perform in 74% of these cases. No premedication was used in 64% of the attempts at scapular manipulation, and these patients reported pain ratings similar to those of the premedicated groups. No complications were noted in this study.

CONCLUSION: Scapular manipulation generally is a simple, rapid, and reliable technique for the reduction of anterior shoulder dislocation.