Videos

If a picture says a thousand words, then we think a video is worth ten thousand! Rather than simply describing techniques, here are real life examples of shoulder reductions performed on real patients, as well as video walkthroughs of reduction techniques performed on models. If you have a video you would like us to feature, please contact us.

Technique and Description Download
Neil Cunningham gives a talk at the International Conference on Emergency Medicine, in Dublin, Ireland, 2012. Here is the talk along with his slides.

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Here a shoulder reduction is attempted, however the operator is unable to get the patient to adduct. This is not uncommon. Neil Cunningham walks through troubleshooting this problem and manages to manoeuvre the shoulder into position for relocation. Check out more on analgesic positions here.

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This video shows a shoulder reduction being attempted, using non-sedating methods. However, it is unsuccessful, and eventually a touch of sedation is used to control the muscle spasm. This results in a quick reduction.

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Neil Cunningham performs a relocation on a patient with an anterior dislocation using the Cunningham Technique. Notice in the video that the arm is held in adduction, and the patient is in Analgesic Position 1. Neil asks the patient if he is in any pain – the patient says no, and he has not been given any analgesia. With the Cunningham Technique there is no yanking or pulling involved, and the traction applied is very gentle.

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Cunningham Technique – with the elbow flexed to 90 degrees. Once again, there is no traction involved, and the patient is asked to relax. The patient has their arm adducted, and is painfree, despite recieving no analgesia. Notice the scar on the anterior part of his shoulder – this patient already had a rotator cuff repair following a previous dislocation.

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Here we have the Cunningham Technique being performed on a patient. Notice the starting position, where the patients arm is slumped to the side with the scapula anteverted (rotated around to the front). Slowly and gently the arm is moved into adduction, and towards Analgesic Position 1. No traction is applied, and the shoulder reduces easily. This patient had no analgesia prior to relocation and had an associated greater tuberosity fracture following a fall from a bicycle.

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Kocher’s Method being performed on a patient in the emergency department by Dr Cunningham.

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Zero Position Technique being performed on a patient in the emergency department by Dr Cunningham.

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This video describes the Modified Milch Method of relocating a shoulder. The modification fixes the scapula so that the zero position can be reached with minimal movement to the affected arm.

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Modified Milch Method. This version is performed from the front of the patient, and often needs an assistant. The modification fixes the scapula so that the zero position can be reached with minimal movement to the affected arm. Notice the gentle traction and arm movements.

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Scapular Manipulation Method. This is a useful technique for those that present with an abducted shoulder or those with a greater tuberosity fracture, as they benefit from Analgesic Position 2. It relies mostly on a cooperative patient and, as the name suggests, rotation of the scapula. One again this technique needs an assistant, and does not require a lot of traction. It can also be performed with the patient lying prone.

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Kocher’s method. Kocher is considered a pioneer in shoulder reduction, and you can see a copy of his original article, translated from German here. Kocher’s method is good for someone who presents with a adducted dislocated shoulder, as it begins by placing them in Analgesic Position 1. Watch the video for a simple demonstration of Kocher’s method.

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This is a video animation of the anatomical structures that come into play with a shoulder dislocation. Click Here for a further description of the anatomy.

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Cunningham Technique – the same video as the second one above, but this time with subtitles, in case you have trouble with the New Zealand accent.

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We would like thank the patients and staff who appear in these videos. All patients and staff gave their consent before and after the relocation and agreed for these videos to be used for educational purposes.

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