General Articles

References Article Link
Review Articles
Cunningham N. Techniques for reduction of anteroinferior shoulder dislocation. Em Med Aust 2005; 17: 463–471. [EXPAND Abstract]

Dislocation of the shoulder joint is common. The shoulder is affected in up to 60% of all major joint dislocations, one study citing an incidence of 1.7% in the general population. The most common form is anteroinferior dislocation. A variety of techniques to reduce shoulder dislocation has been described. The key to successful relocation is a thorough understanding of the anatomy of both the enlocated and the dislocated shoulder joint.[/EXPAND]

Cunningham Technique - EMJ
Radiology
Hendey GW, Kinlaw K. Clinically significant abnormalities in postreduction radiographs after anterior shoulder dislocation. Ann Emerg Med 1996; 28(4): 399-402. [EXPAND Abstract]

Postreduction radiographs rarely reveal any clinically significant abnormality after an anterior shoulder dislocation has been reduced. Emergency physicians and orthopedic surgeons should question whether the time and expense of obtaining routine postreduction films in the ED for anterior shoulder dislocations is justified. A prospective study is needed to validate our findings.[/EXPAND]

Annals of Emergency Medicine
Hendey GW. Necessity of radiographs in the emergency department management of shoulder dislocations. Ann Emerg Med 2000; 36(2): 108-13. [EXPAND Abstract]

Physicians are highly accurate in the clinical determination of shoulder dislocation and relocation. Radiographs should be obtained when the physician is uncertain of dislocation or reduction. Prereduction films should be obtained for patients with a blunt traumatic mechanism of injury, and postreduction for those found to have a fracture-dislocation. However, postreduction films add little in patients without fractures, and neither prereduction nor postreduction films are likely to affect the ED management of patients with recurrent dislocation by an atraumatic mechanism. Prospective validation of the derived algorithm is suggested.[/EXPAND]

Annals of Emergency Medicine
Ceroni D, Sadri H, Leuenberger A. Radiographic evaluation of anterior dislocation of the shoulder. Acta Radiol 2000; 41: 658-61. [EXPAND Abstract]

To establish radiographic criteria to choose the most appropriate technique of reduction for each type of anterior glenohumeral dislocation, and to determine the type of dislocation which requires general anesthesia. Most subcoracoid dislocations (84.4%) could be reduced by the Boss-Holzach-Matter method while only a few subglenoid dislocations (15.8%) were reducible by this technique. Displaced associated fractures significantly reduced the success rate of the reduction attempts.[/EXPAND]

Analgesia
Kolb JC, Krupnick J. Shoulder reduction without anesthesia. Ann Emerg Med 1996; 28(5): 581-2. [EXPAND Abstract]

Although the issue of shoulder reduction may be overdiscussed in the emergency medicine literature, we risk yet another comment. [/EXPAND]

Annals of Emergency Medicine
Swoboda TK, Munyak J. Review of sedation analgesia for closed shoulder reduction in the emergency department: is it safe and effective? Ann Emerg Med 2000; 36(4) Suppl: S69. [EXPAND Abstract]

No abstract available[/EXPAND]

Annals of Emergency Medicine
Burton JH, Bock AJ, Strout TD, Marcolini EG. Etomidate and midazolam for reduction of anterior shoulder dislocation: a randomised controlled trial. Ann Emerg Med 2002;40(5): 496-504. [EXPAND Abstract]

We determine whether patients with acute, anterior shoulder dislocation undergoing emergency department procedural sedation and analgesia (PSA) with intravenous etomidate would experience a reduced time of impaired consciousness when compared with a group of patients receiving intravenous midazolam. Etomidate provides effective PSA for reduction of ED patients with anterior shoulder dislocation. When compared with midazolam, etomidate use confers a significantly shorter period of PSA.[/EXPAND]

Annals of Emergency Medicine
Miller SL, Cleeman E, Auerbach J, Flatow EL. Comparison of intra-articular lidocaine and intravenous sedation for reduction of shoulder dislocations. J Bone Joint Surg 2002; 84A(12); 2135-9. [EXPAND Abstract]

Use of intra-articular lidocaine to facilitate reduction with the Stimson technique is a safe and effective method for treating acute shoulder dislocations in an emergency room setting. Intra-articular lidocaine requires less money, time, and nursing resources than does intravenous sedation to facilitate reduction with the Stimson technique.[/EXPAND]

Journal of Bone and Joint Surgery
General
Murrell GAC. Treatment of shoulder dislocation: is a sling appropriate? MJA 2003; 179 (7): 370-1. [EXPAND Abstract]

Acute anterior shoulder dislocations, when managed non-operatively, have traditionally been treated by placing the arm in a sling. There is no formal evidence that this treatment is of benefit. Three recently reported studies, one in cadavers and two in patients, suggest that the detachment of the structures in the front of the shoulder is made worse when the shoulder is placed in internal rotation, as when the arm is in a sling. By contrast, the structures are realigned when the arm is placed in external rotation. Shoulder dislocations, if managed non-operatively, should not be treated by placing arms in a sling. Rather, placing them in a splint or using a pillow so that the the arm is externally rotated should be considered.[/EXPAND]

PDF Link
Marks TOM, Kelsall NKR, Southgate JJ. Bilateral luxatio erecta: Recognition and reduction. Em Med Aust 2011. 23: 510-11. [EXPAND Abstract]

Luxatio erecta is the rarest form of shoulder dislocation, accounting for 0.5% of all glenohumeral dislocations. Bilateral cases are rarer still with only 12 accounts described in medical literature. We describe an unusual case and its management.[/EXPAND]

Articles
Baker CL, Uribe JW, Whitman C. Arthroscopic evaluation of acute initial anterior shoulder dislocations. Am J Sports Med 1990. 18:25-28. Abstract
Hersche O, Gerber C. Iatrogenic displacement of fracture-dislocations of the shoulder. J Bone Joint Surg [Br] 1993. 76-B:30-33. Abstract
Davids JR, Richard D, Talbott D. Luxatio Erecta Humeri. Clin Orthop 1990;252:144-149. Abstract
Donovan PJ, Paulos LE. Common injuries of the shoulder – diagnosis and treatment. West J Med 1995;163:351-9. [EXPAND Abstract]

Shoulder pain is often the presenting complaint of patients seeing their primary care physicians. Overuse and traumatic injuries make up most of the causes. A physical examination with minimal diagnostic tests can lead to the correct diagnosis in most cases. Most conditions can be treated conservatively (nonsurgically). Appropriate referral to a specialist depends on the severity of the initial injury or the patient’s lack of response to conservative treatment (or both). We discuss common injuries of the shoulder, emphasizing a practical diagnostic and therapeutic approach.[/EXPAND]

Western Journal of Medicine
Quillen DM, Wuchner M, Hatch RL. Acute shoulder injuries. Am Fam Physician 2004; 70: 1947-54. [EXPAND Abstract]

The shoulder is the most mobile joint in the human body. The cost of such versatility is an increased risk of injury. It is important that family physicians understand the anatomy of the shoulder, mechanisms of injury, typical physical and radiologic findings, approach to management of injuries, and indications for referral. Eighty percent of shoulder dislocations are anterior. Diagnosis of this injury is straightforward. The injury usually can be reduced by employing a number of nonsurgical techniques.[/EXPAND]

American Family Physician
te Slaa RL, Wijffels MPJM, Brand R, Marti RK. The prognosis following acute primary glenohumeral dislocation. J Bone Joint Surg [Br] 2004; 86-B: 58-64. [EXPAND Abstract]

We have studied 105 patients with 107 acute, primary, dislocations of the glenohumeral joint seen between January 1, 1991 and July 1, 1994. The mean time of follow-up was 71 months (46 to 91). In 34% the injury occurred during a sports activity and in 28% at home. The bias toward sport was even greater in patients less than 40 years of age, and in men. In patients older than 40 years of age, and in women, the dislocation occurred more often at home. The overall probability of recurrence within four years was 26%. Age was the most significant prognostic factor in recurrencewhich took place in 64% of patients less than 20 years of age and in 6% of those older than 40 years. Statistically, there was no difference between the rates of recurrence in patients who were active in sport and those who were not. The mean Rowescore for the whole group was 87 (15 to 100). Associated fractures were found in 20 patients (19%) and nerve injuries in 22 (21%). None of those in whom a fracture of the greater tuberosity wasseen subsequently suffered a recurrent dislocation.[/EXPAND]

PDF Link
Douoguih WA. Treatment of traumatic anterior shoulder instability in the contact and collision athlete. Curr Opin Orth 2005; 16(2): 82-8. [EXPAND Abstract]

Participation in contact and collision sports places athletes at increased risk of recurrent traumatic anterior shoulder instability. Therefore, treating orthopaedists need to have an excellent understanding of anatomy, associated injuries, pathophysiology and current surgical techniques in order to effectively get players back on to the field.[/EXPAND]

Fongemie AE, Buss DD, Rolnick SJ. Management of shoulder impingement syndrome and rotator cuff tears. Am Fam Physician 1998; 57(4): 667-78. [EXPAND Abstract]

Rotator cuff impingement syndrome and associated rotator cuff tears are commonly encountered shoulder problems. Symptoms include pain, weakness and loss of motion. Causes of impingement include acromioclavicular joint arthritis, calcified coracoacromial ligament, structural abnormalities of the acromion and weakness of the rotator cuff muscles. Conservative treatment (rest, ice packs, nonsteroidal anti-inflammatory drugs and physical therapy) is usually sufficient. Some patients benefit from steroid injection, and a few require surgery.[/EXPAND]

American Family Physician
Labriola JE, Lee TQ, Debski RE, McMahon PH. Stability and instability of the glenohumeral joint: the role of the shoulder muscles. J Shoulder Elbow Surg 2005; 14 Suppl 1: 32S-38S. [EXPAND Abstract]

Shoulder muscles contribute to both mobility and stability of the glenohumeral joint. To improve treatments for shoulder instability, we focused on the contribution of the shoulder muscles to glenohumeral joint stability in clinically relevant positions. Both computational and experimental models were used. A computational model of the glenohumeral joint quantified stability provided by active muscle forces in both mid-range and end-range glenohumeral joint positions. Compared with mid-range positions, the resultant joint force at end-range positions was more anteriorly directed, indicating that its contribution to glenohumeral joint stability was diminished. In end-range positions, simulated increases in rotator cuff muscle forces tended to improve stability whereas increases in deltoid or pectoralis major muscle forces tended to further decrease stability.[/EXPAND]

Here is a list of references and useful articles. Some are available free on the web, whereas you may have access to others via your institution (e.g. Athens Login), or via subscription. Articles that are freely available have been provided with PDF links. If there is a reference that you think would be useful to have on our website, then please contact us.

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