I found this interesting information about a technique for shoulder reduction called the Cunningham technique. It requires no sedation and uses not brute force to reduce the shoulder. Basically it boils down to this:
- Put the patient’s hand on your shoulder, this flexes at the elbow and shortens the biceps a little bit. Put your hand in their antecubutal fossa and put some gentle downward traction.
- Adduct the arm, put it against the body. If the patient pulls away from their side, instruct them to put it back.
- Massage the biceps and trapezius to try to relax some spasm. Remind the patient that if they feel the shoulder moving, not to tense up. The key is to relax.
- Have the patient sit up straight (no slouching forward or to the side – correct this posture if it exists) and then stick their chest out and shoulders back. This brings the scapula back, much as you’d do with scapular manipulation.
- Have them shrug the shoulders upward.
- It should go in without much fuss.
Now I’ve not tried this but heard of several people doing it with success. There’s actually a whole website called shoulderdislocation.net dedicated to various techniques.
Let me know if you try it and it works (or doesn’t). Or watch this video of Mark Harmon reducing Will Ferrel’s shoulder.
my peripheral brain 
Seems like a great technique. Can’t wait to try it and see this magic myself!
This works really well – I’ve done it a few times after hearing about it and then watching a demonstration on YouTube. 100% success rate so far – and all cases have appeared “difficult” to start with (big muscley guys, very anxious women etc). The key is adequate analgesia and relaxation. I start with fentanyl – 100mcg and go up in 50 mcg. If there is inadequate relaxation after 200-300 mcg, add a small dose of midazolam (1-2 mg). Getting the patient to talk to their friend / family also assists relaxation. Then: back straight,shoulders back and chest out – slowly and steadily. It just works. I find that gentle (downward) traction on the arm actually hinders the reduction when it is occurring, so just let the shoulder go back in by itself. It is very elegant to watch as it is a very gentle technique. Should definitely be used as your first method. May take some time to achieve adequate relaxation of the patient (pharmacological) – without this, success is unlikely. Ideally, the patient will become a bit “dopey” – you don’t want them more sedated than this as they need to be able to sit up and interact with you. Good luck.
Wow. Good tip with the fentanyl, I’ll have to try that. Ever since I posted this I have not seen ONE shoulder dislocation.
Ha, ha. Life is like that, isn’t it? I had kind of lost interest in shoulder reductions until an ED mate of mine told me about this. Now I want to rack up a bit of experience using it. It’s fun, especially with an audience and after spending 5-10 min (or longer!) getting the patient adequately analgesed and lightly sedated. You kind of think it’s not going to happen, but then all of a sudden the patient relaxes (often when distracted) and it goes back in.