Patients education of a self-reduction technique for anterior glenohumeral dislocation of shoulder.

BACKGROUND : Anterior dislocation of the shoulder (glenohumeral joint) is one of the most prevalent dislocations. Following a first dislocation recurrence rates of up to 80% have been reported. Many patients will seek medical assistance for reduction of the shoulder after each of these recurrent dislocations. We describe the results of reduction of anterior glenohumeral dislocation using a modified self manipulated Milch technique that can be performed by the patients themselves after simple guidance and demonstration. This method is directed to patients who are not willing or cannot have surgical stabilization and may be in a place where medical assistance is not available. PATIENTS : The patient is placed in a supine position, and begins slowly to actively abduct and externally rotate the dislocated shoulder until the arm is overhead. Once the overhead position has been achieved, the arm is gently lowered back to the side of the body. Simultaneously, the patient has to apply pressure to the front of the shoulder with the other hand to maintain position until the reduction is complete. RESULTS : Thirty-two dislocated shoulders in 33 consecutive patients suffering from recurrent dislocations were successfully reduced by this technique. Mean reduction time was 10 minutes. DISCUSSION : The results illustrate the fact that most patients are able to reliably and reproducibly reduce glenohumeral dislocations by themselves. Subsequent dislocations can be reduced promptly decreasing the dislocation time thus avoiding further damage to the shoulder, achieving immediate pain relief, and removing the immediate necessity for medical attendance.