How to reduce a shoulder with the FARES technique

Siamak Moayedi, MD
19th Nov 2020

The FARES (FAst, REliable, and Safe) technique for shoulder reduction relies on the idea that muscle spasms and tension are keeping the shoulder from going back in. Therefore, the most important part of this technique is a gentle up-and-down oscillation of the shoulder while applying traction.

 

How to reduce a shoulder with the FARES technique

  1. Have the patient lay down on a stretcher with the affected arm close to the edge. Apply traction towards you while gently moving the arm up and down about 5 cm from the neutral position, with two up-and-down cycles per second.
  2. As you are pulling the arm towards you and oscillating up and down, start to slowly abduct the arm away from the patient’s side. Continue this technique until you’ve oscillated the arm to reach 90°of shoulder abduction. This may take over two minutes. 
  3. While continuing to oscillate and abduct the arm, gently externally rotate the shoulder. You’ll feel a clunk when the shoulder pops back in place.
  4. The reduction usually happens by the time you get to 120° of abduction, but if it happens a little earlier, stop then.  
  5. Once the shoulder is back in, gently internally rotate the shoulder and bring the forearm across the chest, with the affected hand touching the opposite shoulder. 

How to reduce a shoulder with the FARES technique: Multi-component image of clinician oscillating, abducting, and externally rotating arm to reduce shoulder. Cartoon. 

Figure 1. Reducing a shoulder with the FARES technique. 1) Apply traction and oscillate the arm. 2) Gently abduct the arm to 90°. 3) Externally rotate the shoulder while continuing to oscillate and abduct the arm. 4) The reduction usually happens by 120°. 5) Place the arm across the chest. 

You’re well on your way to mastering the FARES technique. Keep up the good work!

 

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