Cunningham shoulder reduction

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Analgesic position.jpg
Biceps massage for Cunningham Technique Biceps massage for cunningham technique.jpg
Biceps massage for Cunningham Technique

Cunningham shoulder reduction was originally published in 2003 [1] and is an anatomically based method of shoulder reduction that utilizes positioning (analgesic position), voluntary scapular retraction, and bicipital massage. It is designed for true anterior/subcoracoid glenohumeral dislocations in patients who can fully adduct their humerus. [2] This is distinct from anteroinferior/subglenoid glenohumeral dislocations for which alternative techniques should be used. [3] The method is one of several techniques used for shoulder reduction. [4] [5] [6]

Contents

Mechanism

Shoulder dislocation is a common complication of upper limb trauma (arm pulled while in abduction or direct impact to shoulder) resulting with the humeral head sitting anteriorly out of the glenoid fossa.

Technique is as follows: [2]

Step 1 Sit patient up (without slouching, towel or pillow down spine) and place into analgesic position. ‘Hold’- take control of the affected limb with a 'hold.' This is a firm steady downward hold (not a pull) designed to move the humeral head towards where it needs to be, taking off some of the stretch from the capsule (reducing pain), and providing confidence to the patient that you have taken control of the limb. Once you are in this position, it can be useful to ask the patient their pain level, and explain again what you are going to do. It’s important to note that the elbow is not being supported from below, but is being placed in a downwards ‘hold’. The affected arm is adducted (next to the body) and the elbow fully flexed (optimally shortens the biceps muscle, allowing full relaxation) The humerus points directly down and should be in a neutral position (no forward flexion or external rotation). Ask the patient to “shoulders back, chest out.” (reducing scapular anteversion and so reducing the static obstruction of the glenoid rim). Kneel next to your patient and place your wrist onto their forearm, with their hand resting on your shoulder.

Step 2 Massage the biceps. Ask your patient to again put “shoulders back, chest out” and relax. Massage the biceps (gently) at mid humeral level. Wait for your patient to fully relax and the humeral head slips back into place. Tell your patient that they will feel “strange” as the joint slips back in and not to fight this movement. Continue to gently move the humerus forwards and back in order to find the perfect angle, and provide a small amount of momentum to allow the head to slide across the glenoid.

Step 3 anterior/posterior humeral movements. The humerus can then be gently moved forwards and back in order to find the perfect angle, and provide a small amount of momentum to allow the head to slide across the glenoid. This combines the principle of overcoming the movement inertia with the apposition of the slippery articular surfaces of the glenoid rim and the humeral head.

Success

If performed correctly most patients do not require analgesia for the performance of this technique. [7] Inappropriate use of traction will result in pain for the patient with subsequent spasm and failure to reduce. If the patient is unable to adduct the humerus, or unable to cooperate with positioning, the technique should not be attempted. The patient may require analgesia or sedation if they are in pain or unable to relax spasming muscles.[ citation needed ]

Related Research Articles

<span class="mw-page-title-main">Humerus</span> Long bone of the upper arm

The humerus is a long bone in the arm that runs from the shoulder to the elbow. It connects the scapula and the two bones of the lower arm, the radius and ulna, and consists of three sections. The humeral upper extremity consists of a rounded head, a narrow neck, and two short processes. The body is cylindrical in its upper portion, and more prismatic below. The lower extremity consists of 2 epicondyles, 2 processes, and 3 fossae. As well as its true anatomical neck, the constriction below the greater and lesser tubercles of the humerus is referred to as its surgical neck due to its tendency to fracture, thus often becoming the focus of surgeons.

<span class="mw-page-title-main">Rotator cuff</span> Group of muscles

The rotator cuff is a group of muscles and their tendons that act to stabilize the human shoulder and allow for its extensive range of motion. Of the seven scapulohumeral muscles, four make up the rotator cuff. The four muscles are the supraspinatus muscle, the infraspinatus muscle, teres minor muscle, and the subscapularis muscle.

<span class="mw-page-title-main">Shoulder problem</span> Medical condition

Shoulder problems including pain, are one of the more common reasons for physician visits for musculoskeletal symptoms. The shoulder is the most movable joint in the body. However, it is an unstable joint because of the range of motion allowed. This instability increases the likelihood of joint injury, often leading to a degenerative process in which tissues break down and no longer function well.

<span class="mw-page-title-main">Shoulder</span> Part of the body

The human shoulder is made up of three bones: the clavicle (collarbone), the scapula, and the humerus as well as associated muscles, ligaments and tendons. The articulations between the bones of the shoulder make up the shoulder joints. The shoulder joint, also known as the glenohumeral joint, is the major joint of the shoulder, but can more broadly include the acromioclavicular joint. In human anatomy, the shoulder joint comprises the part of the body where the humerus attaches to the scapula, and the head sits in the glenoid cavity. The shoulder is the group of structures in the region of the joint.

<span class="mw-page-title-main">Upper limb</span> Consists of the arm, forearm, and hand

The upper limbs or upper extremities are the forelimbs of an upright-postured tetrapod vertebrate, extending from the scapulae and clavicles down to and including the digits, including all the musculatures and ligaments involved with the shoulder, elbow, wrist and knuckle joints. In humans, each upper limb is divided into the arm, forearm and hand, and is primarily used for climbing, lifting and manipulating objects.

<span class="mw-page-title-main">Teres minor muscle</span>

The teres minor is a narrow, elongated muscle of the rotator cuff. The muscle originates from the lateral border and adjacent posterior surface of the corresponding right or left scapula and inserts at both the greater tubercle of the humerus and the posterior surface of the joint capsule.

<span class="mw-page-title-main">Shoulder joint</span> Synovial ball and socket joint in the shoulder

The shoulder joint is structurally classified as a synovial ball-and-socket joint and functionally as a diarthrosis and multiaxial joint. It involves an articulation between the glenoid fossa of the scapula and the head of the humerus. Due to the very loose joint capsule that gives a limited interface of the humerus and scapula, it is the most mobile joint of the human body.

<span class="mw-page-title-main">Shoulder girdle</span> Set of bones which connects the arm to the axial skeleton on each side

The shoulder girdle or pectoral girdle is the set of bones in the appendicular skeleton which connects to the arm on each side. In humans it consists of the clavicle and scapula; in those species with three bones in the shoulder, it consists of the clavicle, scapula, and coracoid. Some mammalian species have only the scapula.

<span class="mw-page-title-main">SLAP tear</span> Medical condition

A SLAP tear or SLAP lesion is an injury to the glenoid labrum. SLAP is an acronym for "superior labral tear from anterior to posterior".

<span class="mw-page-title-main">Glenoid fossa</span> Part of the shoulder

The glenoid fossa of the scapula or the glenoid cavity is a bone part of the shoulder. The word glenoid is pronounced or and is from Greek: gléne, "socket", reflecting the shoulder joint's ball-and-socket form. It is a shallow, pyriform articular surface, which is located on the lateral angle of the scapula. It is directed laterally and forward and articulates with the head of the humerus; it is broader below than above and its vertical diameter is the longest.

<span class="mw-page-title-main">Glenohumeral ligaments</span>

In human anatomy, the glenohumeral ligaments (GHL) are three ligaments on the anterior side of the glenohumeral joint. Reinforcing the anterior glenohumeral joint capsule, the superior, middle, and inferior glenohumeral ligaments play different roles in the stability of the head of the humerus depending on arm position and degree of rotation.

<span class="mw-page-title-main">Dislocated shoulder</span> Injury

A dislocated shoulder is a condition in which the head of the humerus is detached from the shoulder joint. Symptoms include shoulder pain and instability. Complications may include a Bankart lesion, Hill-Sachs lesion, rotator cuff tear, or injury to the axillary nerve.

Shoulder surgery is a means of treating injured shoulders. Many surgeries have been developed to repair the muscles, connective tissue, or damaged joints that can arise from traumatic or overuse injuries to the shoulder.

<span class="mw-page-title-main">Bankart lesion</span> Medical condition

A Bankart lesion is a type of shoulder injury that occurs following a dislocated shoulder. It is an injury of the anterior (inferior) glenoid labrum of the shoulder. When this happens, a pocket at the front of the glenoid forms that allows the humeral head to dislocate into it. It is an indication for surgery and often accompanied by a Hill-Sachs lesion, damage to the posterior humeral head.

<span class="mw-page-title-main">Hill–Sachs lesion</span> Cortical depression in the posterolateral head of the humerus

A Hill–Sachs lesion, or Hill–Sachs fracture, is a cortical depression in the posterolateral head of the humerus. It results from forceful impaction of the humeral head against the anteroinferior glenoid rim when the shoulder is dislocated anteriorly.

<span class="mw-page-title-main">Shoulder replacement</span>

Shoulder replacement is a surgical procedure in which all or part of the glenohumeral joint is replaced by a prosthetic implant. Such joint replacement surgery generally is conducted to relieve arthritis pain or fix severe physical joint damage.

Humeral avulsion of the glenohumeral ligament (HAGL) is defined as an avulsion of the inferior glenohumeral ligament from the anatomic neck of the humerus. In other words, it occurs when we have disruption of the ligaments that join the humerus to the glenoid. HAGL tends to occur in 7.5-9.3% of cases of anterior shoulder instability. Making it an uncommon cause of anterior shoulder instability. Avulsion of this ligamentous complex may occur in three sites: glenoid insertion (40%), the midsubstance (35%) and the humeral insertion (25%). Bony humeral avulsion of the glenohumeral ligament (BHAGL) refers when we have HAGL with bony fracture.

Yergason's test is a special test used for orthopedic examination of the shoulder and upper arm region, specifically the biceps tendon.

The Latarjet operation, also known as the Latarjet-Bristow procedure, is a surgical procedure used to treat recurrent shoulder dislocations, typically caused by bone loss or a fracture of the glenoid. The procedure was first described by French surgeon Dr. Michel Latarjet in 1954.

<span class="mw-page-title-main">Shoulder reduction</span>

Shoulder reduction is the process of returning the shoulder to its normal position following a shoulder dislocation. Normally, closed reduction, in which the relationship of bone and joint is manipulated externally without surgical intervention, is used. A variety of techniques exist, but some are preferred due to fewer complications or easier execution. In cases where closed reduction is not successful, open (surgical) reduction may be needed. X-rays are often used to confirm success and absence of associated fractures. The arm should be kept in a sling or immobilizer for several days, prior to supervised recovery of motion and strength.

References

  1. Cunningham, Neil (2003). "A new drug free technique for reducing anterior shoulder dislocations". Emergency Medicine Australasia. 15 (5–6): 521–524. doi:10.1046/j.1442-2026.2003.00512.x. PMID   14992071.
  2. 1 2 "Cunningham | DISLOCATION.COM.AU". dislocation.com.au. Archived from the original on 2020-02-13.
  3. "Algorithmic approach | DISLOCATION.COM.AU". dislocation.com.au. Archived from the original on 2020-02-13.
  4. Neil Cunningham, MBBS, FACEM. "Cunningham Technique". dislocation.com.au.{{cite web}}: CS1 maint: multiple names: authors list (link)
  5. Walsh, R; Harper, H; McGrane, O; Kang, C (2012). "Too good to be true? Our experience with the Cunningham method of dislocated shoulder reduction". The American Journal of Emergency Medicine. 30 (2): 376–7. doi:10.1016/j.ajem.2011.09.016. PMID   22100465.
  6. Cunningham, NJ (2005). "Techniques for reduction of anteroinferior shoulder dislocation". Emergency Medicine Australasia. 17 (5–6): 463–71. doi:10.1111/j.1742-6723.2005.00778.x. PMID   16302939. S2CID   18146330.
  7. Þorsteinn H. Guðmundsson; Guðmundsson, Þorsteinn; Björnsson, Hjalti Már; Hjalti Már Björnsson (2017-09-07). "Rétting á fremra liðhlaupi í öxl með Cunningham-aðferðinni". Læknablaðið. 2017 (9): 373–376. doi: 10.17992/lbl.2017.09.150 . PMID   29044033.