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another way to reduce a shoulder. "cunningham technique"


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Jesus.

Have you ever done this? I cannot imagine it working in ANY patient that I have seen.. I don't have the technique down any where near enough to ever relax the muscles enough for it to pop back in.. Editorially, I think this is due to my opinion that generally Americans are a bunch of pusses who cannot tolerate even the THOUGHT of discomfort in their life.

Jesus.

Have you ever done this? I cannot imagine it working in ANY patient that I have seen.. I don't have the technique down any where near enough to ever relax the muscles enough for it to pop back in.. Editorially, I think this is due to my opinion that generally Americans are a bunch of pusses who cannot tolerate even the THOUGHT of discomfort in their life.

  • Moderator

had just started to do this with a friend in the woods with in minutes of it going out... never got to even do it as just supination/pronation and reaching in front with elbow at side sort of slid it back in..... I think the key is to have young healthly people with higher pain threasholds that have only been out a very brief time so the real spasms have not had a chance to kick in.... this guy is not the typical american and I would agree 100% that american's are a bunch-o-wimps....

  • Moderator

had just started to do this with a friend in the woods with in minutes of it going out... never got to even do it as just supination/pronation and reaching in front with elbow at side sort of slid it back in..... I think the key is to have young healthly people with higher pain threasholds that have only been out a very brief time so the real spasms have not had a chance to kick in.... this guy is not the typical american and I would agree 100% that american's are a bunch-o-wimps....

  • Moderator

yeah, I would think only with a very small subsect of people-basically just rolling the head back into place.... slow ER with the elbow pinned against a pillow(or another spacer between body and elbow about 3-5" thick) over 5-10 minutes is the way I was taught... this is likely the only thing I would try when I am out in the woods with a friend who dislocates....

  • Moderator

yeah, I would think only with a very small subsect of people-basically just rolling the head back into place.... slow ER with the elbow pinned against a pillow(or another spacer between body and elbow about 3-5" thick) over 5-10 minutes is the way I was taught... this is likely the only thing I would try when I am out in the woods with a friend who dislocates....

  • 3 weeks later...

I used it about 3 weeks ago on a 61yo woman. She was about 1.5 hrs post-dislocation and had had two previous dislocations and was worrying that I would have to do "what they did last time. Wrapping me in sheets and pulling on me and shooting me up with drugs"

 

I told her that I wanted to try a new technique that didn't involve any of that and how 'bout letting me give it a whirl. She was understandably skeptical but about 3 minutes later it slid in slicker than owl snot. 'Clunk' No meds. No force. She was amazed (and frankly so was I). So my experience is 100% success, but N=1. Looking forward to trying it again.

I'm now anxious to try this as well. The last 5 or so I have reduced in the ED were done rather easily with slight traction, scapular manipulation and trying to relax the pt. This was all w/o meds. It was nice that the first 2 were folks who have dislocated many times before.

I've actually had this done to me. Felt no pain the whole time. A little sore the next day, but nothing major. The guy doing it didn't even tell me he was going to do it; he just said, "I'm going to rub your shoulder to help you relax and see exactly what's going on." Then wham bam, it rolled back into place and we were done.

i talked to my colleague about this technique several months ago after seeing a youtube video of it. None has try it yet, so no direct feedback. I look forward to giving it a try though. If it doesn't work, i can always revert back to the stimson technique

There was an article in EPM in June I think (their website is unfortunately NOT searchable by month) that described having the patient shrug their shoulders from time to time while you're massaging/de-spasming (maybe it adds a little scapular rotation?)

  • 4 weeks later...

So I've been wanting to try this technique since reading about it here, and finally got a patient today who I thought might be a good candidate. Sat him down, explained the process, and after 5 minutes of massaging and holding, it hadn't budged. Ended up doing intra-articular lidocaine for anesthesia and external rotation, and 30 seconds later it was back in place. First time using the lidocaine technique, and I have to say it worked beautifully; the patient was pain-free within a minute and had no problems with me manipulating him.

  • 4 weeks later...

Just did this the other day with one of my attendings. It didn't work, but I think it was because the patient had some baseline MR and wasn't able to fully cooperate. But we were able to reduce him without sedation, as his muscle tone was poor and with just a tiny bit of traction it popped right back in. I'm looking forward to trying it again. The guy says he's had something like 90% success rate with it? My theory is that it's because Australians are tougher than us. ;-)

  • 10 months later...
  • Moderator

Just tried this and it worked like a dream. No iv. Took about 5 min.

I had the girlfriend do the massage part while i did the rest.

skinny guy. first dislocation.

I figure this technique probably saves folks a few thousand bucks(no IV, no IV meds, No procedural sedation/recovery, less rn time, no rt time, etc)

2 times with success. One was a drunk lady who flat out said, "I'm drunk. Don't give me a bunch of medicine that will make me stop breathing. Just get it back." Can't beat that for getting the thumbs up from the patient.

 

Number two was a guy on his 6th or 7th dislocation. He straight up said he couldn't afford the x-rays or the sedation medication, refused both, and just wanted me to reduce it then and there in the triage chair.

 

The piercing scream when you initially go to exam the shoulder is usually the tip-off to "Cunningham ain't gonna work."

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