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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Hovelius L. Incidence of shoulder dislocation in Sweden. Clin Orthop Relat Res. 1982;166:127–31.
Pasila M, et al. Early complications of primary shoulder dislocations. Acta Orthop Scand. 1978;49(3):260–3.
Beeson MS. Complications of shoulder dislocation. Am J Emerg Med. 1999;17(3):288–95.
Lee AJ, et al. Luxatio erecta: a prehospital challenge in patient packaging. Emerg Med J. 2009;26(10):745–6.
Lagrabette JF, et al. Interscalene brachial plexus block for glenohumeral luxation in prehospital medicine. Ann Fr Anesth Reanim. 2008;27(4):338–40.
Simonet WT, et al. Incidence of anterior shoulder dislocation in Olmsted County. Minnesota. Clin Orthop Relat Res. 1984;186:186–91.
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.
Simonet WT, Cofield RH. Prognosis in anterior shoulder dislocation. Am J Sports Med. 1984;12(1):19–24.
Antal CS, et al. Injuries to the axillary due to anterior dislocation of the shoulder. J Trauma. 1973;13(6):564–6.
Weile F, Fjeldborg O. Lesions of the axillary artery associated with dislocation of the shoulder. Acta Chir Scand. 1971;137(3):279–81.
Ebel R. The cause of axillary nerve paresis in shoulder luxations. Monatsschr Unfallheilkd Versicher Versorg Verkehrsmed. 1973;76(10):445–9.
CEM Clinical Standards (online) (2010). Available from: http://secure.collemergencymed.ac.uk/asp/document.asp?ID=4688. Accessed 6 Sept 2010.
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.
Anderson D, Zvirbulis R, Ciullo J. Scapular manipulation for reduction of anterior shoulder dislocations. Clin Orthop Relat Res. 1982;164:181–3.
Tomcovcik L, et al. Dislocation of the humerus–diagnosis and the Arlt method of reduction. Rozhl Chir. 2001;80(1):38–42.
Shoulder DM. Shoulder. In: Rosen P, editor. Emergency medicine: concepts and clinical practice. 4th ed. St. Louis: Mosby; 1998. p. 728–9.
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.
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.
Kothari RU, Dronen SC. Prospective evaluation of the scapular manipulation technique in reducing anterior shoulder dislocations. Ann Emerg Med. 1992;21(11):1349–52.
Ceroni D, Sadri H, Leuenberger A. Anteroinferior shoulder dislocation: an auto-reduction method without analgesia. J Orthop Trauma. 1997;11(6):399–404.
Westin CD, et al. Anterior shoulder dislocation. A simple and rapid method for reduction. Am J Sports Med. 1995;23(3):369–71.
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.
Cunningham NJ. Techniques for reduction of anteroinferior shoulder dislocation. Emerg Med Australas. 2005;17(5–6):463–71.
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.
Yanturali S, et al. Luxatio erecta: clinical presentation and management in the emergency department. J Emerg Med. 2005;29(1):85–9.
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).
Author information
Authors and Affiliations
Corresponding author
Appendix
Appendix
Emergency doctor’s vehicle, Bavarian Red Cross Neustadt, Germany.
Emergency doctor’s vehicle, German Red Cross Bad Bergzabern, Germany.
Emergency doctor’s vehicle, German Red Cross Merzig-Wadern, Germany.
Rescue helicopter ADAC Air Rescue Ochsenfurt, Germany.
Rescue helicopter, SHS Air Rescue Kaltenbach, Austria.
Emergency doctor’s vehicle, Professional fire brigade Hamburg, Germany.
Emergency doctor’s vehicles, Professional fire brigade Bonn, Germany.
Emergency doctor’s vehicles, Professional fire brigade München, Germany.
Emergency doctor’s vehicles, Professional fire brigade Münster, Germany.
Rescue helicopter, Federal Ministry of the Interior Hamburg and Eutin, Germany.
Rescue helicopters Heli-Ambulance Team Sölden and Zell am See, Austria.
Rights and permissions
About this article
Cite this article
Helfen, T., Ockert, B., Pozder, P. et al. Management of prehospital shoulder dislocation: feasibility and need of reduction. Eur J Trauma Emerg Surg 42, 357–362 (2016). https://doi.org/10.1007/s00068-015-0545-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00068-015-0545-5