I hope I never go through this again. I dislocated my dominant arm sliding into home plate. I just hit my hand and arm on the dirt in the wrong position with the right amount of force and it popped out. No one on the field could get it back in (though they tried)! The emergency room doctor couldn't either, so I ended up with surgery. Was it a mistake to let the EMTs on the field attempt to relocate it?
Shoulder dislocations as a result of a fall and/or sports injury are fairly common. Car accidents are also a major cause of shoulder dislocations. Emergency medical technicians (EMTs) have very specific training for situations like this. They do it more often than others so they tend to have more highly developed skills needed to reduce or relocate the joint.
Some techniques seem to work better than others. But there are also patient factors that can get in the way. If the patient's pain level is high, there is likely going to be muscle guarding and splinting. In other words, the muscles contract and hold the arm in place to protect it. Trying to manipulate it back into place against the force of those muscles can make the problem worse.
Even in the best of situations, it's possible that no technique will be successful (for whatever reasons). In those cases, the patients must be anesthetized (sedated or temporarily put to sleep with medications). Under the influence of the anesthetic, the arm moves smoothly through its motion and the surgeon can gently put the head of the humerus back in the socket.
Surgery to open the joint and repair or reconstruct it is rare but can happen. The exact reasons why one person might have a successful nonoperative reduction while another needs major surgery remain unclear. Scientists are studying this problem and looking for the best way to treat it quickly, easily, and with as little pain as possible. The goal is to avoid surgery while still regaining full shoulder motion and function.
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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