I am a first-year orthopedic resident working on a presentation to the staff on outpatient (closed) shoulder reduction. I've learned how to do three different techniques (the Hippocratic method, the Milch method, and the Kocher method). Are there any studies to suggest one of these is better than the other?
Orthopedic surgeons from Greece think they may have found a new way to quickly reduce an anterior shoulder dislocation with far less pain than two other methods commonly used. For those who don't know what that means, reducing the shoulder joint simply means to put the head of the humerus (upper arm bone) back in the shoulder socket.
The new technique is called the FARES method, which stands for fast, reliable, and safe. It is done with the patient lying on his or her back. The doctor faces the patient and holds the patient's hand while the patient's arm is down at his side. The elbow is straight and the thumb is pointing up. This position puts the forearm is in a neutral or midline position. A gentle traction force is placed on the hand to pull the arm down away from the patient's head.
Then the arm is slowly moved away from the body, a movement called abduction. The clinician continues to pull the arm gently downward toward the feet while applying a vertical (up and down) oscillating movement. When the arm is abducted to about 90 degrees, the examiner gently rotates the patient's arm into a position of external (outward) rotation. Now the palm is facing the ceiling.
The arm is gently pulled up toward the patient's head with continued traction and oscillating motions. When the arm is abducted about 120 degrees away from the side of the body, the humeral head slips back into the socket and the shoulder is reduced.
In this study, they compared how well the FARES technique for anterior shoulder reduction compared with two other methods commonly used (the Hippocratic method and the Kocher method). Each of these other methods are similar to the FARES method but with slight differences. Since you already know how to do these other techniques, we will keep our focus on the results rather than describe each method in detail. The Milch technique you mentioned wasn't tested in this study.
The authors concluded that the FARES method of anterior shoulder dislocation reduction is safe and reliable while being faster and less painful than two other methods tested. The Kocher method was faster than the Hippocratic method but more painful for the patient. The FARES method can be done by medical students and residents who don't have a lot of practice yet. It is a simple technique that can be done by one person. And it can be used without the expense of medications (pain relievers or muscle relaxers) or an operation.
More studies are needed to confirm these findings and to compare the FARES method of shoulder reduction with other techniques that were not considered in this study. As common as anterior shoulder dislocations are, finding the best method to reduce it that can be used in the emergency department or outpatient clinics is an important goal.
Fares E. Sayegh, MD, et al. Reduction of Acute Anterior Dislocations: A Prospective Randomized Study Comparing a New Technique with the Hippocratic and Kocher Methods. In Journal of Bone and Joint Surgery. December 2009. Vol. 91-A. No. 12. Pp. 2775-2882.
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