Dislocated Shoulder (cont.)
How is a dislocated shoulder treated?
The purpose of the initial treatment of a dislocated shoulder is to reduce
the dislocation and return the humeral head to its normal place in the glenoid
fossa. There are a variety of methods that may be used to achieve this goal. The
decision as to which one to use depends upon the patient, the situation, and the
experience of the clinician performing the reduction. Regardless of the
technique used, the hope is to be able to efficiently reduce the dislocation
with a minimum of anesthesia required. Most often, the reduction is closed,
meaning that no incision or cut is made into the joint to assist in returning
the bones to their normal position. The term "open reduction" refers to performing
surgery to repair the dislocation. Methods for reduction of a shoulder
dislocation are described below.
Scapular manipulation
The patient may be sitting up or lying prone. The health-care provider
attempts to rotate the shoulder blade, dislodging the humeral head, and allowing
spontaneous relocation.
External rotation (Hennepin maneuver)
With the patient lying flat, the health-care provider flexes the elbow to 90
degrees and gradually rotates the shoulder outward (external rotation). Muscle
spasm may be able to be overcome after five to 10 minutes, allowing the shoulder to
spontaneously relocate. The Milch technique adds gentle lifting of the arm above
the head to achieve reduction.
Traction-counter traction
With the patient lying flat, a sheet is looped around the armpit. While the
health-care provider pulls down on the arm, an assistant, located at the head of
the bed, pulls on the sheet to apply counter traction. As the muscles relax, the
humeral head is able to return to its normal position.
Open reduction
In rare circumstances, the shoulder cannot be reduced using closed reduction
techniques because a tendon, ligament, or piece of broken bone gets caught in
the joint, preventing return of the humeral head into the glenoid. When closed
reduction fails, an operation or open reduction is considered to treat the
shoulder dislocation. This requires the patient to go to the operating room.
Procedural medications
Depending upon the amount of pain and spasm present, medication may be needed
to sedate and comfort the patient prior to and during the reduction procedure.
Intravenous narcotics and muscle relaxants are often used in combination to
relieve pain, relax muscles, and help promote amnesia of the events. Common pain
medications used include morphine, hydromorphone (Dilaudid), and fentanyl. Midazolam (Versed) is often used as a muscle relaxant because of its additional
amnesiac effect. Other relaxants include diazepam (Valium), lorazepam (Ativan),
and others.
Intra-articular (intra = within + articular = joint) injections of lidocaine
into the shoulder joint itself may be used as local anesthesia.
Next: What happens after reduction of a shoulder dislocation? »
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