SCAPULAR MANIPULATION TECHNIQUE FOR REDUCING ANTERIOR SHOULDER DISLOCATIONS – IMPROVEMENT BY MODIFICATION

Abstract

Introduction: Scapular manipulation is one of the most successful techniques for reducing anterior shoulder dislocations. However, as there is evidence in the literature that elbow flexion can avoid tendon interposition and muscular compression forces on the glenohumeral joint are at a minimum in the overhead position, we created a modification of the original technique with the principle of scapular manipulation in overhead position and traction on the upper arm with the elbow flexed. The aim of this study was to assess the effectiveness of this new method.

Methods: 62 patients with acute anterior shoulder dislocation who were treated with this new method were evaluated prospectively with regard to primary success rate and reduction time as main outcome parameters. Results were compared to the published data on the original method. Statistics was conducted using the chi-square test and the ANOVA post hoc test with Bonferroni-Dunn-transformation.

Results: 59 of the 62 dislocations (61% first time dislocations, 21% with associated fractures) were reduced successfully by use of the new method by 21 different physicians indicating a primary success rate of 95.2%. The mean reduction time was 3.13 minutes. Primary success rates of the original method reported in 5 studies range from 78.4 to 96.0% (mean 87.1%). In 2 out of 5 single test and global level comparisons our new modification revealed a statistically significant better primary success rate compared to the original method (p< 0.05). There were no iatrogenic complications in our study, and the method was easy to perform even without any experience in reducing shoulder dislocations.

Conclusion: Modification by overhead position and elbow flexion can even improve the high primary success rate of the original scapular manipulation technique. Therefore, the method is strongly recommended as a first choice technique for reducing anterior shoulder dislocations.