How to reduce a shoulder with the external rotation method

Like the Cunningham technique, the external rotation method is another easy way to reduce a dislocated shoulder without sedation.

The external rotation method involves four simple steps:

1. Flex the elbow to 90°.
2. Adduct the arm to bring it close to the side of the chest, and bring the shoulder into 20° of forward flexion. This promotes relaxation of the structures in the front of the shoulder, specifically the anterior capsule.
3. At 20° of flexion, slowly externally rotate the shoulder until the forearm is almost in the same plane as the chest. At this point, the shoulder will be reduced.
4. Once the shoulder is reduced, internally rotate the arm to bring it over the abdomen.

Now, you may be wondering what to do about the anxious patient that won’t let you get close to them. Try an anxiolytic. If this calms your patient, continue with the external rotation method. But if this doesn’t work, you will need to sedate them before using this technique.

Excellent work! Now you know the steps to perform the external rotation method on cooperative (and uncooperative) patients.

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