Procedure - Shoulder Reductions Flashcards
What are contraindications to joint injection?
Anticoagulation
Bleeding disorders
- The risk of hemarthrosis is too high.
For a shoulder dislocation, where should you inject the anesthetic?
Lateral (over the midpoint of the deltoid)
Review the method of external rotation (Kocher).
1) Patient is sitting upright against the bed.
2) You are sitting at the affected side, sitting facing the same direction as your patient.
3) Place whichever of you hands is closest to the patient on top of their AC joint. Keep their elbow adducted with this technique. Use your other hand (the one farther away) to grab their affected arm’s hand.
4) Keep the patient’s elbow at their side, fully adducted.
5) Slowly (millimeters at a time) externally rotate and keep pressure. Hold for a minute or two at 90 degrees of external rotation.
Note, this method only works with the elbow at the side. If the patient can’t fully adduct then don’t attempt.
If the external rotation (Kocher) technique fails, what method should you pivot to (at the end of Kocher)?
The Milch technique:
1) When the shoulder is at 90 degrees of external rotation, abduct the arm as much as you can (usually about 120 degrees).
2) When you are at the peak of abduction, bring the arm forward.
The only technique that works for inferior shoulder dislocations is what?
Traction-countertraction
What are tips for inferior reductions?
You can only do traction-countertraction. Pull axial traction and bring the arm anterior-inferior. While doing this have an assistant push superiorly on the humeral head.
What is the proper way to do scapular manipulation?
The goal is to angle the tip of the scapula toward the spine. Using both of your hands, grab the superior and medial borders of the scapula with your fingers. Put both thumbs onto the outer edge of the tip of the scapula. Then shift the scapula toward the spine.
Review the components of the Cunningham technique.
1) Have the patient sitting upright.
2) Sit facing the patient with their affected elbow at their side and the affected hand on your shoulder.
3) Massage the deltoid, biceps, and trapezius muscle.
4) Instruct the patient to shrug their shoulders back.
Review the steps of the FARES (FAst, REliable, and Safe) technique.
1) Have the patient lie supine.
2) Beginning with their hand pointing down and adducted, start oscillating up and down in gentle but quick movements.
3) Slowly and gently begin to abduct the arm while oscillating.
4) At about 90 degrees of abduction, rotate the hand from downward to upward.
5) Once you are at maximal abduction, bring the arm anterior and inferior (like the end of the Milch technique).
- Note, you are not doing traction – th oscillations are meant to relax the arm.
When you do the Davos (autoreduction) technique, which knee are they supposed to use?
Ipsilateral to the dislocation
*Note, have the patient tape their hands together so that they don’t have to engage their muscles.
** Also have them tilt their head back so that it relaxes the shoulders.
Before and after reducing a dislocated shoulder, what do you need to check?
Axillary nerve function (patch distribution of sensation)
How long does a patient need to remain in a sling post reduction?
It depends on age:
*Less than 40 years: 7-10 days
*Older than 40 years: 5-7 days
