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July 2015 Shoulder Reduction Techniques 

July Journal Club kicks off our 2015-2016 academic year and we would like to extend a warm welcome to our new interns, PA's, Fellows & Attending staff. One of the most satisfying procedures in EM is the reduction of an acutely dislocated shoulder. That stated, it can also be one of the most frustrating when your usual “go-to” approach is unsuccessful.

Despite a myriad of reduction techniques, the strength of the evidence in favor of any one technique is not great. EBM teaches us to rely upon local expertise and patient values.  We thought JC might be a great venue to assess the evidence and solicit the expertise of our expert community faculty. I also happen to know that there will be a few former patients in attendance. So...feel free to tweet your perspective as a patient or superstar clinician  who can share your series of patients that respond to your Jedi technique.  

P: In patients with an acute anterior elbow dislocation                                                                                   

I: Does use of the FARES, Stimson, Milch, Kocher, chair, scapular, Eskimo (no kidding), self-reduction      

C: Compared to Hippocratic (sheets and toga’s)                                                                                           

O: Provide better outcomes (time to reduction, pain, attempts or perceived greatness of clinician)

Milch versus Stimson technique for nonsedated reduction of anterior shoulder dislocation: a prospective randomized trial and analysis of factors affecting success. J Shoulder Elbow Surg. 2012 Nov;21(11):1443-9

A new drug free technique for reducing anterior shoulder dislocations. Emerg Med (Fremantle). 2003 Oct-Dec; 521-4.

Reduction of acute anterior dislocations: a prospective randomized study comparing a new technique with the Hippocratic and Kocher methods.J Bone Joint Surg Am. 2009 Dec;91(12):2775-82