Cunningham shoulder reduction was originally published in 2003 and is an anatomically based method of

shoulder reduction 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 ...

that utilizes positioning (analgesic position), voluntary scapular retraction, and bicipital

massage Massage is the manipulation of the body's soft tissues. Massage techniques are commonly applied with hands, fingers, elbows, knees, forearms, feet or a device. The purpose of massage is generally for the treatment of body stress or pain. In E ...

. It is designed for true

anterior Standard anatomical terms of location are used to unambiguously describe the anatomy of animals, including humans. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position prov ...

/subcoracoid glenohumeral dislocations in patients who can fully adduct their

humerus 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 roun ...

. This is distinct from anteroinferior/subglenoid glenohumeral dislocations for which alternative techniques should be used. The method is one of several techniques used for

Mechanism

Shoulder dislocation is a common complication of upper limb trauma (arm pulled while in

abduction Abduction may refer to: Media Film and television * "Abduction" (''The Outer Limits''), a 2001 television episode * " Abduction" (''Death Note'') a Japanese animation television series * " Abductions" (''Totally Spies!''), a 2002 episode of an ...

or direct impact to shoulder) resulting with the humeral head sitting anteriorly out of the

glenoid The glenoid fossa of the scapula or the glenoid cavity is a bone part of the shoulder. The word ''glenoid'' is pronounced or (both are common) and is from el, gléne, "socket", reflecting the shoulder joint's ball-and-socket form. It is a sha ...

fossa. Technique is as follows: 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 Standard anatomical terms of location are used to unambiguously describe the anatomy of animals, including humans. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position prov ...

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 The biceps or biceps brachii ( la, musculus biceps brachii, "two-headed muscle of the arm") is a large muscle that lies on the front of the upper arm between the shoulder and the elbow. Both heads of the muscle arise on the scapula and join ...

. 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 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 ro ...

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

Success

If performed correctly most patients do not require

analgesia Pain management is an aspect of medicine and health care involving relief of pain (pain relief, analgesia, pain control) in various dimensions, from acute and simple to chronic and challenging. Most physicians and other health professionals ...

for the performance of this technique. Inappropriate use of traction will result in pain for the patient with subsequent

spasm A spasm is a sudden involuntary contraction of a muscle, a group of muscles, or a hollow organ such as the bladder. A spasmodic muscle contraction may be caused by many medical conditions, including dystonia. Most commonly, it is a muscle ...

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 Sedation is the reduction of irritability or agitation by administration of sedative drugs, generally to facilitate a medical procedure or diagnostic procedure. Examples of drugs which can be used for sedation include isoflurane, diethyl ethe ...

if they are in pain or unable to relax spasming muscles.

References

{{reflist Orthopedic treatment