The scapular manipulation technique is perfect for when you’re very busy and don’t have enough time to calm your patient down.
How to reduce a shoulder with scapular manipulation
First, have your patient lay on a stretcher on their stomach, with their dislocated arm hanging down. You can leave them in this position for a while, and if they relax enough, sometimes the weight of the arm combined with relaxation will allow for spontaneous reduction of the shoulder.
If you return and the shoulder is still out, then you can add the scapular manipulation technique:
- Find the bottom of the scapula.
- Slowly and gently push the scapula away from you. This should reposition the glenoid socket instead of moving the humeral head.
- Apply gentle downward traction on the arm.
- Apply gentle internal and external rotation to overcome spasms.
The reduction can be very subtle, so you may need to re-examine the shoulder intermittently.
How to select the right patient for scapular manipulation
Keep in mind, this technique is not necessarily safe if you need to administer a sedative. It’s hard to manage the airway of a patient that’s laying on their chest, and there is a risk of the patient falling off the stretcher. Choose your patients wisely when using this technique.
Great work! You’ve now covered the summary for performing the scapular manipulation technique.
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- Alkaduhimi, H, van der Linde, JA, Willigenburg, NW, et al. 2017. A systematic comparison of the closed shoulder reduction techniques. Arch Orthop Trauma Surg. 137: 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 Traumatol. 10: 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 Am. 91: 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 Med. 50: 656–659. PMID: 26899512