Fig. 346
Exhibits a subcoracoid dislocation and the position of the patient in his endeavor to find relief from pain. (Mudd.)
Treatment.
—Prompt reduction is the only treatment for shoulder or other dislocations. This may be first attempted without anesthesia. Should muscle spasm prevent easy reduction it should be relaxed by an anesthetic, for which purpose nitrous oxide will often suffice. In the forward or forward and downward dislocations it will sometimes be sufficient to simply make firm traction in a direction obliquely outward and upward, with rotation. When this is insufficient it may be assumed that there is more or less laceration of the capsule and entanglement of the head of the bone, as well as that it is caught around the border of the glenoid cavity, against which it is firmly held.
The above simple maneuver failing, the luxation is to be reduced by a more scientific manipulation, in which traction figures largely, the method now generally in vogue being that suggested by Kocher, by which rotation and leverage are added to traction, and a minimum of power made to do a maximum of good. Kocher’s method is especially applicable to the anterior displacements. It consists of a triple manipulation whose three stages are portrayed in [Figs. 347] to [349]. The first procedure is to flex the forearm to a right angle with the arm, apply the former firmly to the side, and then, while keeping the elbow at the side, forcibly rotate the limb outward until the forearm points away from the body ([Fig. 348]). This having been done the arm is abducted and the elbow moved upward until the limb is in the horizontal plane of the shoulder, the scapula being held firmly during these movements, as shown in [Fig. 348]. After the arm has been brought to the level of the shoulder it is rotated inward and brought downward by a process of circumduction, the elbow being made to describe some part of the arc of a circle as it comes down. The displaced head should slip into place during this movement, and will do so unless the capsular tear is too small. In that case the movements should be repeated, perhaps with more force, until the opening is sufficiently enlarged to permit the button-hole in the capsule to slip over the head of the bone.
Fig. 347
First position in Kocher’s rotation method.
Fig. 348