How to reduce a shoulder with the external rotation method

Not sure how to reduce a shoulder? Learn about the external rotation method, a technique that requires no sedation!
Last update19th Nov 2020

Like the Cunningham technique, the external rotation method is another easy way to reduce a dislocated shoulder without sedation.

How to reduce a shoulder with the external rotation method

The external rotation method involves four simple steps:

  1. Flex the elbow to 90°.
  2. Adduct the arm to bring it close to the side of the chest, and bring the shoulder into 20° of forward flexion. This promotes relaxation of the structures in the front of the shoulder, specifically the anterior capsule.
  3. At 20° of flexion, slowly externally rotate the shoulder until the forearm is almost in the same plane as the chest. At this point, the shoulder will be reduced.
  4. Once the shoulder is reduced, internally rotate the arm to bring it over the abdomen.
Figure 1. Reducing a dislocated shoulder with the external rotation method. 1) Flex the elbow. 2) Adduct the arm and place the shoulder in 20° flexion. 3) Externally rotate the shoulder until the shoulder is reduced. 4) Internally rotate the arm to bring it over the abdomen.

Now, you may be wondering what to do about the anxious patient that won’t let you get close to them. Try an anxiolytic. If this calms your patient, continue with the external rotation method. But if this doesn’t work, you will need to sedate them before using this technique.

Excellent work! Now you know the steps to perform the external rotation method on cooperative (and uncooperative) patients.

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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

About the author

Siamak Moayedi, MD
Professor and Director of Medical Student Education, University of Maryland and Course Director, Essential and Critical Procedures, Emergency Medicine.
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ACCME accredited, UEMS accredited, Comenius EduMedia Siegel 2017, BMA Highly recommended