Anaesthesia for reduction of anterior dislocations of the shoulder.

Sir, Further to Mr A. Banerjee's letter to your journal regarding the requirement of anaesthesia for reduction of anterior dislocations of the shoulder, while agreeing with him that anaesthesia is not necessary for the majority of patients, I would like to point out that in the original description by Theodore Kocher published in 1881 there is no mention of traction during the manoeuvre. In fact, Kocher describes flexion at the elbow with the arm parallel to the chest, lateral rotation of the humerus, flexion at the shoulder, adduction and lastly internal rotation. He claimed that anterior sub-coracoid dislocation of the shoulder can be reduced without either assistants or anaesthesia, provided that neither the glenoid rim nor the greater tuberosity were fractured and that capsular damage was not so extensive that the bone surfaces were not held apposed. In our department we have used Kochers method without anaesthesia or analgesia for 42 consecutive anterior subcoracoid dislocations of the shoulder since August 1990 with a success rate of 40 out of 42. The two failures were due to undiagnosed greater tuberosity fracture, and subsequently required general anaesthesia.