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.