Northwestern University Feinberg School of Medicine

Orthopedic Teaching

Shoulder Case 3 ED Management

Anterior Shoulder Dislocation


ED Management

Reduction techniques require adequate muscle relaxation and analgesia which may require conscious sedation or intra-articular analgesia. Several techniques have been described; details are beyond the scope of this content:

  1. The Stimson technique of hanging weights from the forearm of the prone patient.
  2. The two person technique of traction-countertraction with bedsheets.
  3. External rotation of Leidelmeyer performed on the supine patient.
  4. Elevation maneuver of Cooper and Milch.
  5. Scapular manipulation.

The neurovascular exam is then repeated, a sling and swathe is placed, and post-reduction x rays are checked for reduction and fractures.

Shoulder immobilization is maintained for 3-6 weeks in younger patients, 1-2 weeks in patients over 40. Primary dislocations or complicated cases (fracture, rotator cuff injury, axillary nerve injury) require orthopedic follow-up.