1
15
Equipment Required: None
Steps:
1. Operator: Have the patient prone. Grasp both the wrist and forearm.
2. Operator: Slowly oscillate the adducted arm in an up & down motion. Work up to 2-3 oscillations per second.
3. Operator: Slowly continue to abduct the shoulder while maintaining axial traction.
4. Operator: Reach 120° of shoulder abduction for reduction.
5. Place arm in a shoulder sling post reduction and perform a neurovascular exam.
1
20
Equipment Required:
1. Kerlix gauze or 2-4 inch gauze roll with tape or one single bedsheet
Steps:
1. Have patient put their wrists together beyond a bent knee on the affected side.
2. Wrap the kerlix/gauze roll/bedsheet as a snug fit around the *wrists*, not hands, so that it creates a closed loop around the knee.
3. Ask the patient to gently lean back, elbows straight, letting the shoulder also slowly roll forward.
4. Over the next 15 minutes, ask the patient then to extend their neck to allow passive reduction.
5. Place arm in a shoulder sling post reduction and perform a neurovascular exam.
1
15
Equipment Required: 1. adequate analgesia
Steps:
1. Place patient in a supine position.
2. Extend the arm and slowly lift it at the forearm in anterior abduction.
3. Apply gentle upward traction in an anterior fashion and stop if there is any pain.
4. Once pain subsides, resume slow anterior abduction. Anticipate 5 - 10 minutes for full relaxation.
5. Reduction is usually by 90 degrees of anterior shoulder abduction.
6. Place arm in a shoulder sling post reduction and perform a neurovascular exam.
1
15
Equipment Required: None
Steps:
1. Patient in an upright seated position.
2. Hold the patient’s affected arm in 90° flexion and arm adducted to torso, maintaining mild inferior traction.
3. With other hand, gently massage the trapezius, deltoid, and biceps.
4. Continue gentle massage over 10 minutes until reduction.
5. Place arm in a shoulder sling post reduction and perform a neurovascular exam.
Tips:
1. Can combine simultaneously with scapular manipulation by another provider.
Alt Names: Dangling Weights Technique
1
5
Equipment Required:
1. 5-10 lbs of weights
2. Weight hook
3. Makeshift wrist wrap (from bedsheet or stockinette or velcro wrist splint)
Steps:
1. Lay the patient prone.
2. Wrap the wrist with a bedsheet or stockinette or velcro wrist splint.
3. Hang 5-10 lbs of weights with weight hook.
4. Allow the muscles to relax over 20-30 minutes or until reduction.
5. If needed, add in scapular manipulation, external rotation, or forward flexion.
6. Place arm in a shoulder sling post reduction and perform a neurovascular exam.
1
10
Equipment Required: None
Seated (2-person)
1. Have the patient in a seated position.
2. Assistant: Face the patient and place the patient’s hand in forward traction while keeping the arm parallel to the floor.
3. Assistant: Apply counter traction with other hand on the patient’s clavicle.
4. Operator: Stabilize scapula with one hand on the inferior angle/scapula tip. Place the other hand on the scapular spine/superolateral border
5. Operator: Push the scapula tip/inferior angle towards the spine (medially).
6. Assistant: Provide external rotation to the shoulder (supinate the wrist) as needed.
7. Place the arm in a shoulder sling post-reduction and perform a neurovascular exam.
Prone (1-person)
1. Have the patient in a prone position.
2. Have the affected arm laying over the side of the bed or perform the Stimson technique.
3. Stabilize scapula with one hand on the inferior angle/scapula tip. Place the other hand on the scapular spine/superolateral border
4. Push the scapula tip/inferior angle towards the spine (medially).
5. Place the arm in a shoulder sling post-reduction and perform a neurovascular exam.
2
30
Equipment Required:
1. 2 bedsheets
2. adequate analgesia
3. If adding procedural sedation, end tidal CO2 + monitor
Steps:
1. Assistant: Wrap bedsheet #1 under the patient’s axilla + chest (then hold 2 ends like a jump rope or tie the ends around like a belt).
2. Assistant: Elevate the bed to the hip level of the assistant.
3. Operator: Have the patient’s elbow flexed to 90° and arm abducted to 90°.
4. Operator: Wrap bedsheet #2 around your waist and around the patient’s distal elbow crease.
5. Operator: Apply axial traction by grabbing the forearm and pressure along bedsheet #2.
6. Assistant: Apply counter traction with bedsheet #1.
7. Operator: If needed, apply slight external rotation.
8. Place arm in a shoulder sling post reduction and perform a neurovascular exam.
Alt Names: Hennepin Technique
1
10
Equipment Required: None
Steps:
1. Adduct the patient’s arm.
2. Flex the elbow to 90 degrees.
3. Apply gentle external rotation of the shoulder with the elbows flexed over the next 5 minutes.
4. Stop if there is pain. Allow the pain to reside before resuming.
5. Reduction should occur between 70° - 110° of external rotation.
6. Place arm in a shoulder sling post reduction and perform a neurovascular exam.
1
10
Equipment Required: None
Steps:
1. Place patient in supine or prone position.
2. Apply longitudinal traction along the forearm.
3. Gently move it to full 180° of shoulder abduction overhead.
4. Apply gentle external shoulder rotation.
5. Place arm in a shoulder sling post reduction and perform a neurovascular exam.