How to reduce a shoulder with the Cunningham technique

Siamak Moayedi, MD
19th Nov 2020

The Cunningham technique is a favorite amongst doctors because it doesn’t require sedation or force. It relies on the concept that the humeral head will naturally slip back into its happy place (the glenoid socket), but can’t because of muscle spasms. Before reviewing the steps for the Cunningham technique, let's talk about a few things you can do to improve your success with this technique. 

 

Selecting the right patient for the Cunningham technique 

The, first, and perhaps the most important, thing to do before you perform the Cunningham technique is to make sure you select the right patient. You cannot do this technique on a patient who’s anxious and has difficulty letting you get close to their shoulder.  

If the patient is cooperative, let them know that you won’t hurt them, and that the procedure is painless.  

Anxious female patient beside a calm male patient. Cartoon.

Figure 1. The right patient for the Cunningham technique will be calm and allow you to get close to their shoulder.

 

Building trust with your patient

Great, so you've made sure you've got the right patient. But, before you proceed, you need to gain the patient’s trust by demonstrating the procedure on their non-dislocated arm. Empower your patient with the knowledge that if they relax and decrease the muscle spasm, the shoulder will go right back in. Ask them to close their eyes and tell you about their most relaxing vacation while taking slow and deep breaths.

Building trust in your patient: Male dreaming about a relaxing vacation while taking deep breaths. Cartoon.

Figure 2. Building trust with your patient while performing the Cunningham technique. Tell your patient that if they relax and decrease muscle spasms, the shoulder will go back in. Ask your patient to close their eyes and tell you about their most relaxing vacation. 

 

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Reducing the shoulder with the Cunningham technique 

Once your patient is sufficiently relaxed, you can proceed with the Cunningham technique. Remember, never do any sudden or forceful movements because that will cause pain and spasms and make your job impossible.

Here are the seven steps of the Cunningham technique:

  1. Have your patient sit on a chair with their back nice and straight. Sit in front of them at their level. 
  2. Gently and slowly bring their affected arm close to their body (adduction) with the elbow flexed.
  3. Place their hand on your shoulder. 
  4. Lay your inside hand on their elbow for gentle traction (weight of arm is enough). 
  5. Remind your patient to sit up straight and breathe slowly. 
  6. With the outside hand, massage the trapezius, deltoid, and then the bicep, in that order. Massage (like kneading a strong dough) for about three seconds at each site.  
  7. Repeat this process for about one to two minutes. 

Reducing a shoulder with the Cunningham technique: Multi-component image of male patient sitting with arm on clinician’s shoulder while clinician massages injured arm. Cartoon.

Figure 3. Reducing a shoulder with the Cunningham technique. While your patient is sitting on a chair with their back straight, gently adduct the arm and place their hand on your shoulder. Lay your inside hand on their elbow for traction. Massage the trapezius, deltoid, and bicep for three seconds at each site over one to two minutes. 

After a minute or two the patient will say that they feel better. You won’t necessarily feel a clunk, but the patient will be able to bring their arm across their chest and touch their opposite shoulder!  

Reducing a shoulder with the Cunningham technique: Image of male patient touching opposite shoulder. Cartoon.

Figure 4. Once you’ve performed the Cunningham technique, the patient will be able to bring their arm across their chest and touch their opposite shoulder.

But what if the patient is not cooperative? There are other ways of putting the shoulder back in place, such as the external rotation method, scapular manipulation, and FARES technique.

Fantastic work! You’re well on your way to mastering the Cunningham technique. 

 

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Recommended reading

  • Alkaduhimi, H, van der Linde, JA, Willigenburg, NW, et al. 2017. A systematic comparison of the closed shoulder reduction techniques. Arch Orthop Trauma Surg137: 589–599. PMID: 28251280
  • Cunningham, N. 2003. A new drug free technique for reducing anterior shoulder dislocations. Emerg Med (Fremantle)15: 521–524. PMID: 144992071
  • Marinelli, M, de Palma, L. 2009. The external rotation method for reduction of acute anterior shoulder dislocations. J Orthop Traumatol10: 17–20. PMID: 19384630
  • Sayegh, FE, Kenanidis, EI, Papavasiliou KA, et al. 2009. Reduction of acute anterior dislocations: a prospective randomized study comparing a new technique with the Hippocratic and Kocher methods. J Bone Joint Surg Am91: 2775–2782. PMID: 19952238
  • Stafylakis, D, Abrassart, S, and Hoffmeyer, P. 2016. Reducing a shoulder dislocation without sweating. The Davos technique and its results. Evaluation of a nontraumatic, safe, and simple technique for reducing anterior shoulder dislocations. J Emerg Med50: 656–659. PMID: 26899512