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  1. Hi guys, just want to share with you all that i'm the newest ER PA as of today. Anyways, a friend of mine share a youtube video of a wonderful technique to help reduce anterior shoulder dislocation. The technique appears to be quite gentle for the patient, thus minimizing further trauma. I have never tried it before, but can't wait for the opportunity. I was wondering if any of you guys have heard of it or performed it before? Here's the video: Here's a description that i copy from Diego, a physician in our practice: -Inform the patient of the procedure and the fact that it will be painless. It is important to relax the patient and confident reassurance is the first step towards this. -Sit the patient up with the back vertical. This can be done on a bed, chair or trolley, but preferably seated on a non-wheeled chair without arm rests. -Carefully support the arm while it is moved into the correct position, allowing the patient to help with the other arm. The correct position is with the arm adducted (next to the body) and pointing vertically down, the elbow is flexed at 90 degrees so that the forearm points horizontally and anteriorly. -The operator then squats/kneels to the side of the patient and facing the opposite direction to the patient. The operator then slips the hand between the patients forearm and body so that the patient’s wrist/hand is resting on the operator’s upper arm. Do not make pulling movements at any time as this will elicit pain and result in spasm. -Apply steady, very gentle traction (the weight of the operators forearm is quite enough) directly downwards once the patient is settled and pain free. Keep this gentle weight on the arm throughout, stop if any spasm or pain. Usually resting with the patients arm in this position will start to reduce the pain of spasm. -With the other hand, the operator then massages the trapezius, deltoid and biceps muscle sequentially, repeating this process and concentrating on the biceps brachii until the muscles are fully relaxed. A strong kneading of the biceps with the thumb anterior and the four fingers of the operator posterior to the arm is recommended. At this point the humeral head will relocate usually without any clear indication that the shoulder has reduced (no sound or ‘clunk’ feeling). This means that the shoulder must be observed/checked regularly to confirm when relocation has occurred (with shoulder exposed movement can be seen as the ‘step’ disappears.) http://shoulderdislocation.net/cunningham-technique
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