Usually, in a rural emergency department, trauma presents when human resources are limited. At best there may be a physician and a nurse available, so that there is the option of using procedural sedation if a shoulder dislocation presents. Often, however, the physician may be working alone for a variety of reasons. In this setting, it is useful to have a protocol for reduction which may succeed without the need for sedation. This topic covers one such protocol.
The key to adequate analgesia is intra-articular lidocaine and passage of time. The Stimson method is suggested to start because it requires no active physician participation, and other tasks can be carried out as one awaits reduction. If this fails, scapular rotation is suggested, and this can be carried out with the patient in the same position. The fall back manouvre, if analgesia is sufficient, is to attempt the external rotation method. Any other method will require either sedation or muscle relaxation.