Here are the key points from Kocher’s 1870 article on his method of relocating shoulders.
Muscle spasm (para 2):
The role of muscular tension is noted with reference to resisting forced reduction and he quotes Streubel.
“those which already are put in tension by the dislocation of the joint head will strongly resist any method of reduction by which they are meant to be stretched even further.”
The effect of active muscular spasm on position is also noted, including the difficulty of inferring position during dislocation from findings during dissection or anaesthesia (include paralysis in modern joint operations)
“one cannot draw immediate conclusions from the corpse to the living body, all the more so since it is well known how much the reducing particularly of dislocated shoulders is helped by administering chloroform.”
Contemporary techniques in 1870 (para 8 & 9):
There are several methods that are already being used in 1870. Kocher clearly notes that the first action (manoeuvre 1 – external rotation with humerus adducted) has previously been described by Schinzinger.
He also notes multiple other techniques in use at the time, and includes comment on the similarity of some of these – elevation method, Schinzinger’s and Gordon’s, Richet’s (respectively M. Langenbeck’s), A. Cooper’s abduction method, Lücke (add chloroform to Richet), Hamilton, Mothe.
Traction (para 9):
Kocher dismisses traction/counter traction in 1870 as anatomically inferior
“A. Cooper’s abduction method, in which the surgeon’s heel is wedged into the axilla of the patient lying on the bed and the surgeon pulls at a sling running over the elbow joint of the dislocated arm with his whole body weight, appears to pay no regard to the circumstances of the capsule.”
Anatomy (e.g. para 13):
There is wonderful detail of the anatomy throughout the paper.
e.g. At the end of the external rotation “The point of the humerus lying on the rim of the socket at the end of the external rotation stretching is not part of the joint surface, but part of the rear circumference of the greater tuberosity. It is the outer surface of the same tuberosity that is turned toward the capsular tear.”
Kocher’s method (para 14):
Kocher’s method is designed for the subcoracoid dislocation. The dislocations that Kocher and Dr Otz produced were all subcoracoid (pure anterior dislocations) via an artificially produced anterior capsule tear.
“This method: Pressing the arm bent at the elbow towards the body, turning outward until resistance is felt, lifting of the outwardly rotated upper arm in the sagittal plane as far as possible, and finally slowly turning it inward.”
Contraindications (para 16)
Contraindications to this method are clearly stated.
“If the joint capsule is almost completely ripped off, particularly if upper and anterior wall of the capsule are missing.”
“If the whole mass of the greater tuberosity is not broken off, respectively the posterior circumference of the humeral head is not shattered.” (manoeuvre 2 and 3 require an intact greater tuberosity)
“Finally if the anterior rim of the socket has been avulsed (and not just the glenoid rim) – in those cases the mechanism for rotation is disturbed, the head will turn around its own axis and will not be lifted out laterally.”
Drugs (para 19):
Kocher notes that drugs don’t assist with relocation using this method.
“Since with the suggested method, chloroform is detrimental rather than useful, this paper did not deal with the pendulum and the rubber hoses methods.”
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