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Management of prehospital shoulder dislocation: feasibility and need of reduction

  • T. HelfenEmail author
  • B. Ockert
  • P. Pozder
  • M. Regauer
  • F. Haasters
Original Article

Abstract

Purpose

Dislocation of the shoulder is rare in the prehospital setting. The medical specialities of the emergency physicians are heterogeneous, and the level of experience is different. Aim of this study was to evaluate the feasibility, sufficiency, and need of prehospital reduction.

Methods

Over 12 months, 16 rescue stations in Germany and Austria documented cases. Points of examination were: incidence of reduction, influence of pathological findings, therapy and effectiveness of reduction.

Results

We included 70 patients. A reduction was undertaken in n = 47 (66.6 %). In n = 70 (100 %) perfusion was without pathological finding after reduction, all n = 7 (10 %) neurological pathologies declined after reduction. There was no significance in total implementation of prehospital reduction between surgeons and anaesthetists. N = 63 (90 %) of all patients received an immobilisation of the shoulder. N = 68 (97 %) of all patients were transported to a hospital. Time to arrival in hospital was in n = 50 (71.4 %) ≤10 min, in n = 17 (24.2 %) ≤20 min and in n = 3 (4.4 %) ≤30 min.

Conclusion

Implementation of reduction is independent of pathological neurological or vascular findings. Knowledge and skill is enough to perform a reduction quiet effectively in all emergency physicians. No specific technique can be recommended for prehospital use, the importance of being skilled is more important than one method. Early reduction was performed most rapidly in surgeons, but as well in the recommended time by other medical disciplines. On documented timings to admission hospital waiver of reduction is doubt. Therefore, a reduction in the prehospital setting is possible, but not obligatory.

Keywords

Sholder dislocation Prehospital Treatment Reposition Feasibility 

Notes

Conflict of interest

Tobias Helfen, Ben Ockert, Peter Pozder, Markus Regauer and Florian Haasters declare that they have no conflict of interest.

Compliance with ethical requirements

Approval by the ethical committee has been obtained. (507-14 Ludwig-Maximilians University Munich).

References

  1. 1.
    Hovelius L. Incidence of shoulder dislocation in Sweden. Clin Orthop Relat Res. 1982;166:127–31.PubMedGoogle Scholar
  2. 2.
    Pasila M, et al. Early complications of primary shoulder dislocations. Acta Orthop Scand. 1978;49(3):260–3.CrossRefPubMedGoogle Scholar
  3. 3.
    Beeson MS. Complications of shoulder dislocation. Am J Emerg Med. 1999;17(3):288–95.CrossRefPubMedGoogle Scholar
  4. 4.
    Lee AJ, et al. Luxatio erecta: a prehospital challenge in patient packaging. Emerg Med J. 2009;26(10):745–6.CrossRefPubMedGoogle Scholar
  5. 5.
    Lagrabette JF, et al. Interscalene brachial plexus block for glenohumeral luxation in prehospital medicine. Ann Fr Anesth Reanim. 2008;27(4):338–40.CrossRefPubMedGoogle Scholar
  6. 6.
    Simonet WT, et al. Incidence of anterior shoulder dislocation in Olmsted County. Minnesota. Clin Orthop Relat Res. 1984;186:186–91.PubMedGoogle Scholar
  7. 7.
    Leroux T, et al. Epidemiology of primary anterior shoulder dislocation requiring closed reduction in Ontario. Canada. Am J Sports Med. 2014;42(2):442–50.CrossRefPubMedGoogle Scholar
  8. 8.
    Simonet WT, Cofield RH. Prognosis in anterior shoulder dislocation. Am J Sports Med. 1984;12(1):19–24.CrossRefPubMedGoogle Scholar
  9. 9.
    Antal CS, et al. Injuries to the axillary due to anterior dislocation of the shoulder. J Trauma. 1973;13(6):564–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Weile F, Fjeldborg O. Lesions of the axillary artery associated with dislocation of the shoulder. Acta Chir Scand. 1971;137(3):279–81.PubMedGoogle Scholar
  11. 11.
    Ebel R. The cause of axillary nerve paresis in shoulder luxations. Monatsschr Unfallheilkd Versicher Versorg Verkehrsmed. 1973;76(10):445–9.PubMedGoogle Scholar
  12. 12.
    CEM Clinical Standards (online) (2010). Available from: http://secure.collemergencymed.ac.uk/asp/document.asp?ID=4688. Accessed 6 Sept 2010.
  13. 13.
    Beattie TF, et al. A comparison of the Milch and Kocher techniques for acute anterior dislocation of the shoulder. Injury. 1986;17(5):349–52.CrossRefPubMedGoogle Scholar
  14. 14.
    Anderson D, Zvirbulis R, Ciullo J. Scapular manipulation for reduction of anterior shoulder dislocations. Clin Orthop Relat Res. 1982;164:181–3.PubMedGoogle Scholar
  15. 15.
    Tomcovcik L, et al. Dislocation of the humerus–diagnosis and the Arlt method of reduction. Rozhl Chir. 2001;80(1):38–42.PubMedGoogle Scholar
  16. 16.
    Shoulder DM. Shoulder. In: Rosen P, editor. Emergency medicine: concepts and clinical practice. 4th ed. St. Louis: Mosby; 1998. p. 728–9.Google Scholar
  17. 17.
    Uehara DT, Rudzinski JP. Injuries to the shoulder complex and humerus. In: Tintinalli JE, Kelen DG, Stapczynski JS, editors. Emergency Medicine: a comprehensive study guide. 5th ed. New York: Mcgraw-Hill; 2000. p. 1783–91.Google Scholar
  18. 18.
    Cortes VC, Checa LGD, Vela JR. Reduction of acute anterior dislocations of the shoulder without anaesthesia in the position of maximum muscular relaxation. Int Orthop. 1989;13(4):259–62.CrossRefGoogle Scholar
  19. 19.
    Kothari RU, Dronen SC. Prospective evaluation of the scapular manipulation technique in reducing anterior shoulder dislocations. Ann Emerg Med. 1992;21(11):1349–52.CrossRefPubMedGoogle Scholar
  20. 20.
    Ceroni D, Sadri H, Leuenberger A. Anteroinferior shoulder dislocation: an auto-reduction method without analgesia. J Orthop Trauma. 1997;11(6):399–404.CrossRefPubMedGoogle Scholar
  21. 21.
    Westin CD, et al. Anterior shoulder dislocation. A simple and rapid method for reduction. Am J Sports Med. 1995;23(3):369–71.CrossRefPubMedGoogle Scholar
  22. 22.
    Wakai A, O’Sullivan R, McCabe A. Intra-articular lignocaine versus intravenous analgesia with or without sedation for manual reduction of acute anterior shoulder dislocation in adults. Cochrane Database Syst Rev. 2011;4:CD004919.PubMedGoogle Scholar
  23. 23.
    Cunningham NJ. Techniques for reduction of anteroinferior shoulder dislocation. Emerg Med Australas. 2005;17(5–6):463–71.CrossRefPubMedGoogle Scholar
  24. 24.
    Heidari K, et al. Immobilization in external rotation combined with abduction reduces the risk of recurrence after primary anterior shoulder dislocation. J Shoulder Elb Surg. 2014;23:759–66.CrossRefGoogle Scholar
  25. 25.
    Yanturali S, et al. Luxatio erecta: clinical presentation and management in the emergency department. J Emerg Med. 2005;29(1):85–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • T. Helfen
    • 1
    Email author
  • B. Ockert
    • 1
  • P. Pozder
    • 2
  • M. Regauer
    • 1
  • F. Haasters
    • 1
  1. 1.Department of Trauma SurgeryLudwig-Maximilians-University (LMU) Campus InnenstadtMunichGermany
  2. 2.Faculty of MedicineUniversity of SzegedSzegedHungary

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