Reducing a shoulder means moving the upper arm bone back into the shoulder socket after a dislocation. In an emergency department, the overall success rate for this procedure is about 92%, and several well-established techniques can accomplish it, some requiring no sedation at all. The method used depends on the situation, the patient’s pain level, and whether muscle relaxation can be achieved.
What Happens Before Reduction
Before anyone attempts to put a shoulder back in place, a careful check of nerve and blood vessel function is essential. Axillary nerve injury occurs in over 40% of shoulder dislocations. This nerve controls the deltoid muscle and provides sensation to the outer part of the shoulder. A quick test involves lightly touching the skin on the outside of the upper arm to check for numbness, then asking the patient to try to tense the deltoid. These findings need to be documented before and after the reduction so any new nerve damage can be identified.
If there’s concern about arterial injury, such as a weak or absent pulse in the arm, that takes priority and may require imaging before reduction is attempted. Dislocations with significant nerve or blood vessel compromise should not be subjected to multiple reduction attempts. These cases typically need orthopedic consultation.
The Stimson Technique (Gravity-Assisted)
This is one of the gentlest approaches. The patient lies face down on a raised bed with the injured arm hanging straight down off the edge. A weight of 2 to 4 kilograms (roughly 5 to 9 pounds) is attached to the wrist, and gravity does most of the work by slowly pulling the arm bone downward and allowing the muscles to fatigue and relax. For more muscular patients, the weight can be increased to 6 to 8 kilograms after 10 minutes if reduction hasn’t occurred.
The entire process can take up to 25 minutes. Success rates are around 80%. If the shoulder hasn’t reduced by that point, the attempt is typically stopped and a different approach or sedation is considered. The main advantage here is that it requires minimal force and can work without pain medication in cooperative patients.
External Rotation (Hennepin) Technique
The patient sits or lies on their back with the elbow bent to 90 degrees and tucked against the body. The practitioner then very slowly rotates the forearm outward, like opening a door, while keeping the elbow pressed to the side. The key word is slowly. The rotation needs to happen gradually over several minutes, pausing whenever the patient tenses up, so the muscles have time to relax and release the humeral head back into the socket.
This technique works well because it doesn’t require traction or pulling on the arm. It relies entirely on the natural mechanics of the joint. Many emergency physicians prefer it as a first-line approach because it’s low-force and can often succeed without sedation.
The Cunningham Technique
This method uses no traction or rotation at all. Instead, it focuses on relieving the muscle spasm that’s holding the shoulder out of place. The patient sits upright and is coached to relax by pulling the shoulders back and slightly upward, correcting their posture. While the patient does this, the practitioner massages the biceps muscle at the middle of the upper arm to release the spasm that’s acting as a physical block to reduction.
When the biceps relaxes enough, the humeral head often slides back into the socket on its own. This technique requires a calm, cooperative patient and a practitioner who can coach them through relaxation, but when it works, it’s remarkably gentle.
Scapular Manipulation
This technique repositions the shoulder blade rather than the arm. The patient is typically seated and leaning slightly forward, or lying face down as in the Stimson position. While an assistant applies gentle downward traction on the arm, the practitioner pushes the bottom tip of the shoulder blade inward toward the spine and rotates the top of the shoulder blade outward. This effectively moves the socket to meet the humeral head rather than forcing the humeral head back into the socket.
In one large study of emergency department reductions, scapular manipulation was the most commonly documented technique, used in nearly 29% of cases, with only 2 failures out of 70 attempts.
Self-Reduction for Recurrent Dislocations
People who experience repeated shoulder dislocations can be taught to reduce their own shoulder using the Boss-Holzach-Matter technique (sometimes called the Davos method). This is particularly useful in remote or wilderness settings where medical help isn’t immediately available.
To perform it, you sit on a firm surface and bend the knee on the same side as the dislocated shoulder to 90 degrees, placing the foot flat. Lace your fingers together around that knee. Then slowly lean back, letting your head tilt backward with your neck extended, until both arms are fully straight. This creates a gentle pulling force along the axis of the arm. At the same time, shrug both shoulders forward. The combination of traction from leaning back and the forward shrug of the shoulder blade is often enough to guide the joint back into place.
This technique has been studied in clinical trials and is considered effective and low-risk when taught by a physician. It’s not meant for a first-time dislocation, where the extent of injury is unknown.
Common Injuries That Accompany Dislocation
A shoulder dislocation rarely involves just the bones slipping apart. The soft tissue damage that comes with it is often the real concern for long-term shoulder health. In patients with recurrent traumatic dislocations, a Bankart lesion (a tear of the cartilage rim at the front of the socket) was found in 100% of cases in one study. A Hill-Sachs lesion, which is a dent in the back of the humeral head caused by it impacting the socket rim on the way out, appeared in about 72% of cases.
These injuries are why reduction alone doesn’t fully solve the problem. The torn labrum is what typically leads to recurrent instability, especially in younger patients. Imaging after a first dislocation helps determine how much structural damage occurred and whether surgical repair might eventually be needed.
What Recovery Looks Like After Reduction
Once the shoulder is back in place, the standard approach is immobilization in a sling for about one to three weeks, with the arm held against the body in internal rotation. Most guidelines settle on three weeks as the recommended duration. Immobilizing for longer than three weeks has not been shown to improve outcomes or reduce the chance of the shoulder dislocating again.
Interestingly, the recurrence rate stays roughly the same regardless of how long the sling is worn, whether it’s less than a week or more than three weeks. This has led researchers to explore whether immobilizing in external rotation (arm rotated outward) rather than internal rotation might better position the torn labrum for healing. Studies on cadavers and imaging have shown that a position of about 30 degrees of abduction with 60 degrees of external rotation does the best job of holding the labrum against the bone where it can heal. In practice, this position is harder for patients to maintain, so it hasn’t replaced the standard sling approach universally.
After the immobilization period, rehabilitation focuses on restoring range of motion first, then progressively strengthening the rotator cuff and the muscles around the shoulder blade. The goal is to rebuild the dynamic stability that compensates for whatever structural damage the dislocation caused. Full return to sport or heavy activity typically takes several months.