Best of both (BOB) maneuver for rapid reduction of anterior shoulder dislocation.

This article describes a combination maneuver for the reduction of anterior glenohumeral dislocations. It maximizes the force counter to the patient's musculature by using downward motion, with the physician's body mass and gravity doing the work, and the base of the ED gurney providing countertraction. It couples this force with the benefit of a scapulothoracic manipulation maneuver, which rotates the glenoid fossa into a position more amenable to "reaccepting" the humeral head. Some might regard this as a variation of the scapulothoracic manipulation maneuver. Because minimal sedation and analgesia is necessary, this technique may be useful for shoulder reductions at sporting events, wilderness areas, or accident scenes. It may also expedite the care of patients in busy emergency department settings.