Houston Methodist. Leading Medicine

Shoulder FAQ

Question:

Our 14 year old son dislocated his right shoulder after falling off his mountain bike. He had to have anesthesia to put the joint back in place. Can't they do this without surgery like you see on TV shows like ER or Scrubs?

Answer:

Not all TV drama is real or accurate. Screen writers do try to research conditions, illnesses, and medical procedures and present them accurately.

In the case of shoulder dislocation, there are several ways to "reduce" or put the joint back in place. The most common method of shoulder reduction after dislocation is the traction counter-traction technique. The doctor pulls on the hand of the dislocated arm.

At the same time, pressure is applied into the armpit in the opposite direction. This method of shoulder reduction is often painful and doesn't always work.

Using sedation such as general anesthesia relaxes the muscles around the joint. This allows the head of the humerus to slide over the rim of the socket and slip back into the joint.

What you saw on TV could have been the traction-counter traction method of reduction. Another way to do this is an old method called the Milch technique. The Milch method is a safe and easy way to reduce a dislocated shoulder joint. The patient's arm is moved by the doctor or examiner into a position of 90 degrees of abduction and flexion as if to put the hand behind the head.

The head of the humerus slips back over the rim of the socket and fits back into the joint. No anesthesia and no surgery is required. Because it's not a recent discovery and because it's an old method, all doctors today may not know about the use of the Milch method to avoid surgery for shoulder dislocation. Daniel R. O'Connor, MD, PC, et al. Painless Reduction of Acute Anterior Shoulder Dislocations Without Anesthesia. In Orthopedics. June 2006. Vol. 29. No. 6. Pp. 528-532.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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