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Teaching Patients How to Reduce a Shoulder Dislocation: A Randomized Clinical
Trial Comparing the Boss-Holzach-Matter Self-Assisted Technique and the Spaso
Method
#MMPMID29509614
Marcano-Fernández FA
; Balaguer-Castro M
; Fillat-Gomà F
; Ràfols-Perramon O
; Torrens C
; Torner P
J Bone Joint Surg Am
2018[Mar]; 100
(5
): 375-380
PMID29509614
show ga
BACKGROUND: There are many different techniques for reducing acute anterior
dislocations of the shoulder, and their use depends on surgeon preference. The
objective of this study was to compare the pain experienced by a patient
performing a self-reduction technique with the pain felt during a reduction
performed by a trained physician. METHODS: The study was carried out at the
emergency department of a tertiary referral center. Patients between 18 and 60
years of age with an acute anterior shoulder dislocation were randomly allocated
into 2 groups. In 1 group the emergency doctor actively guided the reduction
process with the Spaso technique (Sp group), and in the other group the patient
used the Boss-Holzach-Matter (also known as Davos or Aronen) self-reduction
technique (BHM group). The pain experienced by the patient during the reduction
was recorded by means of a visual analogue scale (VAS) ranging from 0 to 10.
Other recorded data included demographic characteristics, reduction time, and
success rate. RESULTS: Of 378 patients assessed for eligibility from May 2015
until February 2017, 197 did not meet the inclusion criteria, 58 met exclusion
criteria, 22 declined to participate, and 41 withdrew before randomization. Sixty
acute anterior shoulder dislocations were randomized into the Sp group (n = 30)
or the BHM group (n = 30). The BHM group experienced significantly less pain
during reduction than the Sp group (p = 0.047), with mean pain scores of 3.57
(standard deviation [SD] = 2.1]) and 5.26 (SD = 2.9), respectively. No
significant difference between groups was found with respect to reduction time
(105 seconds [range, 10 to 660 seconds] in the Sp group and 90 seconds [range, 5
to 600 seconds] in the BHM group; p = 0.6) or success rate (67% and 77%,
respectively; p = 0.39). CONCLUSIONS: The self-reduction technique results in
less pain than, and is as efficient in achieving reduction of anterior shoulder
dislocations as, the Spaso technique. These findings favor the use of the
self-assisted method as an effective first-line treatment for shoulder
dislocations seen in the emergency department as well as its use by patients with
recurrent dislocation. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions
for Authors for a complete description of levels of evidence.
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