1. NEVER attempt to reduce the shoulder on the field.
2. NEVER attempt to reduce the shoulder with shoulder pads on.
3. A hospital gurney or other mushy surface makes reduction more difficult. A typical A.T. table is perfect.
4. Avoid reducing the shoulder in the seated position, fainting is possible & would complicate the matter.
5. Use the Mich technique. It is gentle, painless & effective. No thrusting or torquing is involved.
4 comments:
Joe,
A timely blog. Our starting quarterback went down on the field last week with an anterior dislocation of his throwing shoulder. Got him to my portable training table on the sideline, removed his shoulder pads and had him lie prone with the affected arm off the table. He was comfortable with this position. After a few minutes I tried some very gently distraction however it had no effect.
Finally had to summon the ambulance and send him to the local Medical Center (5 minutes away). They injected him with a nerve block and reduced the shoulder. No fracture, MRI revealed a small Bankart lesion.
What is the Mich Technique?
Kevin Moody
http://www.wheelessonline.com/ortho/milch_technique_of_shoulder_reduction
The concept of the procedure is the head of the humerus is trapped under the bicep & subscapularis tendons. By shortening them the tension is reduced and the shoulder spontaneously relocates. Been using it since the early 80's. Has never failed, even on big guys, and relatively painless.
The Bankhart lesion most likely was not from a one shot deal. That shoulder probably had plenty of subluxations previous. FB players bench press alot- and the scapular dyskinesis that goes along with it. Sets up the dislocation.
Thanks Joe.
On another track, I would like to start some discussion with readers about PFPS. I am seeing plenty of high school x-c runners and female soccer players with this syndrome.
I just received Gary Gray's "transformational zone & patellofemoral pain" DVDs but haven't gotten too far into them yet.
Kevin Moody
Joe,
I struggle with reducing at all. I was taught that athletic trainer's shouldn't reduce without images first. I guess my undergrad was conservative in that manner and there was no real collision type sports to yield enough to practice on. I know reducing will make it feel much better but struggle with performing them without images to reduce the risk of liability.
Post a Comment