Reductions of the Shoulder, Patella and Digits Dawn E. Kopf, MMS PA-C Aspen Valley Hospital Emergency Department First and Foremost… Know your Anatomy! Make sure the patient is N/V and motor in tact both at the site of the injury and distally. Identify the Injury

• Shoulder Dislocation • Clavicle Fracture • AC Separation • Fracture-Dislocation

•Begin at the SC joint and work your way out to the shoulder looking for pain, deformity and/or crepitus Clavicle Fracture Acromioclavicular Separation Fracture-Dislocation

***DO NOT PULL ON A FRACTURE!

If you are not sure, leave it alone. Shoulder Dislocation

• Almost always anterior. • Posterior dislocations are rare and associated with electrocution/seizure. • Patient will generally be anxious/uncomfortable. • Key is to keep patient as calm as possible as it is really THEY who will reduce their shoulder. • Look For “Sulcus Sign.”

Techniques in RFFE Handbook

•Cunningham Technique •Auto Reduction •External Rotation •If you ask each provider in the ER…You will probably get a different answer from every one. There are many different techniques and I usually use a combination of several. Position of Comfort

• Patients will likely present in either the “flagged position” or held in adduction/internal rotation.

• It is sometimes easiest to reduce patient in a position similar to that which caused the dislocation in the first place.

• In the field, much of your technique is going to be dependent on the location you are in! Cunningham Technique

•Talk to the patient. •Have the patient focus on breathing and posture. (It provides distraction from what you are doing..) •Positioning, positioning, positioning. •Apply gentle traction along the axis of the humerus. •Be patient! Do We have a Volunteer in the Audience? Auto Reduction Reduction of Digits

• Step 1: Identify the joint Not generally a subtle presentation Reduction Technique

•Place traction on the joint in the same direction in which is dislocated and then apply traction distally and towards proper alignment. •Counter traction at the wrist may be helpful. •Gloves may also help with traction. •Once digit is reduced-try to splint/buddy tape to prevent recurrent dislocation as ligaments/tendons are likely lax. •Volar plate and tendon injuries are often associated with dislocations. •Follow up x rays and further assessment necessary. Patellar Dislocation *Will most often dislocate Laterally Patellar Reduction Technique

• If possible (if patient will let you) try to get the patient supine with their leg cradled in your arm at a 60-90 degree angle. • I find that it is more comfortable for the patient if you put lateral traction on the patella as you gently straighten the leg and “guide” the patella back in to place. • The leg should then be immobilized in a straight leg brace for further evaluation. QUESTIONS?