A shoulder dislocation occurs when the head of the upper arm bone (humerus) separates from the shoulder socket (glenoid fossa). This injury is the most common major joint dislocation, frequently caused by trauma such as a fall on an outstretched arm or a direct impact. The severity of the injury suggests immediate damage to surrounding structures, including ligaments, tendons, and the joint capsule. Due to the high probability of associated injuries, professional medical care is the definitive standard for diagnosis and relocation. This information outlines the principles of self-reduction, which should only be considered in extreme circumstances, such as a wilderness or survival situation where professional medical attention is hours or days away.
Critical Safety Warnings and When Not to Attempt Relocation
Attempting to relocate a dislocated shoulder without medical imaging presents significant risks that can lead to permanent disability. A primary concern is the possibility of an associated fracture, particularly of the humeral head or neck, which occurs in a significant number of cases. Forcing a joint back into place when a fracture is present can worsen the break, potentially creating a complex fracture-dislocation that is far more difficult to treat. The axillary nerve, which runs close to the joint, is the most commonly injured nerve; compromise can result in numbness in the outer shoulder and weakness in the deltoid muscle.
Manipulating the joint without prior assessment risks compounding existing nerve damage or causing a tear in the brachial plexus, the network of nerves supplying the arm. Signs of nerve or vascular compromise, such as numbness, tingling, or a loss of pulse in the arm or hand, are absolute contraindications to self-reduction. A first-time dislocation carries the highest risk of underlying damage, including tears to the labrum or rotator cuff tendons. Medical professionals insist on X-rays before reduction to confirm the type of dislocation and rule out fractures.
Preparing the Joint for Reduction
The primary obstacle to a successful reduction is the involuntary muscle spasm that occurs as the body attempts to protect the injured joint. This painful contraction of the shoulder muscles, particularly the deltoid and rotator cuff, prevents the humeral head from sliding back into the socket. The initial step is to stabilize the injured arm in a supported position that minimizes movement and encourages muscle relaxation. This may involve using a makeshift sling to hold the forearm across the chest or keeping the arm immobile by the side.
Achieving physical and mental relaxation is crucial, as it directly reduces the muscle spasm. Gravity and positioning can be used to encourage this relaxation before manipulation begins. For instance, the patient can be positioned to allow the arm to hang freely, using the limb’s weight to apply gentle, continuous traction. Avoid any sudden, forceful movement, as this will immediately trigger severe muscle contraction and increase pain.
Principles of Self-Reduction Techniques
Successful self-reduction relies on the principle of slow, steady traction and muscle fatigue, not forceful manipulation. The goal is to gently guide the humeral head past the rim of the glenoid socket while the surrounding muscles are maximally relaxed. Low-force methods are preferred for self-reduction as they minimize the risk of iatrogenic damage to the joint capsule, blood vessels, and nerves. These techniques require the patient to be in control to regulate the speed and force based on their pain and muscle resistance.
Modified Milch Technique
The modified Milch technique relies on muscle relaxation and can be performed by the patient. The patient lies on their back and slowly moves the affected arm away from the body (abduction) while rotating the palm upward (external rotation). The arm is gradually lifted overhead until it reaches a fully raised position, then gently lowered back down. During this movement, the patient may use their opposite hand to apply mild pressure to the front of the shoulder, helping to guide the humeral head into place.
Stimson Maneuver
The Stimson maneuver uses gravity and sustained weight to achieve muscle relaxation. The patient lies face down on an elevated surface, allowing the injured arm to hang straight down toward the floor. A weight, typically 5 to 10 pounds (2.5 to 5 kilograms), is secured to the wrist of the hanging arm to provide constant, gentle axial traction. This sustained pull fatigues the spasming muscles, often allowing the shoulder to spontaneously reduce over a period of 15 to 30 minutes.
Cunningham Method
The Cunningham method focuses on muscle manipulation and positioning for passive reduction. The patient sits upright with the arm resting against the chest, focusing on pulling their shoulders back and relaxing the arm muscles. The technique emphasizes gentle massage of the biceps and deltoid muscles. This action helps to lengthen and relax the biceps tendon, allowing the humeral head to slide back without a forceful “clunk.”
Immediate Steps After Relocation
Once the shoulder has successfully reduced, signaled by a palpable or audible clunk and an immediate reduction in pain, immediate care is necessary. The first action is to immobilize the joint completely to prevent recurrence, as the surrounding soft tissues are stretched and unstable. A sling or swathe should hold the upper arm against the body with the elbow bent at a 90-degree angle.
After immobilization, the patient must reassess the arm for any signs of neurovascular injury that may have occurred or worsened during the reduction. This includes checking for sensation in the lateral upper arm and ensuring a strong pulse is present in the wrist. Even if the reduction feels successful, seeking professional medical attention is mandatory. An X-ray is required to confirm the humeral head is seated correctly and to check for any associated fractures. A medical professional will then prescribe immobilization, typically four to six weeks, followed by physical therapy to restore strength and prevent future dislocations.