Reducing a shoulder dislocation with the Cunningham technique

In this video, from our Emergency Procedures Masterclass (Part 2), we take a look at how the Cunningham technique works, why it won't work on every patient, and a step-by-step account of how to perform this procedure.

Siamak Moayedi, MD
Siamak Moayedi, MD
25th Sep 2020 • 3m read

The Cunningham technique is a relatively quick and painless way to reduce a shoulder—but only for the right patient. In this video, from our Emergency Procedures Masterclass (Part 2), we'll take a look at how the Cunningham technique works and why it won't work for every patient, as well as provide a step-by-step account of how to perform this procedure.

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In this course, you will learn a variety of procedures used in emergency medicine. These procedures will help you to diagnose and treat common infections, injuries, and other problems, such as joint infections, dislocations, soft tissue abscesses, and priapism. You’ll also cover the ultimate airway rescue procedure—the cricothyrotomy. This masterclass is a companion to the Emergency Procedures Masterclass (Part 1).

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Video transcript

The first technique and my favorite is the Cunningham technique. Dr. Cunningham is an Australian emergency medicine physician who first described this method in 2003. The reason I love this method is because it doesn't require any sedation or force. It basically relies on the concept that the humeral head wants to go back into it's happy place in the glenoid fossa, but can't because of muscle spasm.

So the first step, and probably the most important step is selecting the right patient for this technique. You can't do this on a patient who's super anxious and won't even let you get close to their shoulder. But if the patient is cooperative, let them know that you won't hurt them, and that the procedure is pretty much painless.

The next step is 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 their muscle spasm, the shoulder will go right back in much easier. Ask them to close their eyes and have them tell you about their most relaxing vacation or ask them to slowly take deep breaths in and out just to relax.

Have the patient sit on a chair with their back nice and straight, no slouching. They need to have good posture for this. Next, gently and slowly bring their affected arm close to their body - that's called abduction. And now the elbow is going to be flexed. Next, have their hand sit on your shoulder, you'll need to sit facing them at their level.

Now, lay your inside hand on their elbow for some gentle traction. Just the weight of your own arm is enough. Remember, never make any sudden or forceful movements, because that will only cause pain and spasm and make your job impossible. You'll have to keep reminding the patient to sit up straight.

With your other hand, the outside one, start massaging the trapezius, and then the deltoid, and then the biceps in that order. The massage is like a strong kneading of dough for about three seconds at each site. Usually within a minute or two, the patient will say they feel much better. You won't necessarily feel a clunk, but the patient will be able to bring their arm across their chest and touch their other shoulder.

I love the look on the family and even the nurses faces after I successfully performed the Cunningham technique. For the correct selected patient, you won't need any sedation or any pain medications. Okay, but what if your patient is not cooperative? In the next lessons, you'll learn some other ways of putting that shoulder back in place.

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