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Three Part Question

In an [adult patient with an anterior dislocation of the shoulder] is [Milch's technique or Scapular Manipulation technique] best at achieving [a successful, uncomplicated reduction].

Clinical Scenario

A 32-year-old healthy man attends the emergency department with a right shoulder injury he sustained during a hockey game. Clinical examination reveals a defect in his glenohumeral joint, an anterior shoulder dislocation and no neurovascular deficits. x Rays reveal an anterior shoulder dislocation and no fracture. You are aware of endless discussion about the "best" technique for reduction and see no reason why you should not join in. In this light you wonder whether the scapular manipulation technique or Milch’s technique is the best at achieving the most successful reduction?

Search Strategy

Ovid MEDLINE 1950 - 2008 February Week 4
Ovid EMBASE 1980 - 2008 Week 9
(exp Shoulder Dislocation/ OR exp Dislocations/ OR
shoulder dislocation$.mp.) AND Milch$.mp.
The Cochrane Library Issue 1 2008 (milch): ti,ab,kw 3 results none relevant.

Search Outcome

MEDLINE: 21 papers found
EMBASE: 10 papers found

Comment(s)

There are several papers that investigated the scapular manipulation technique, but did not compare it with any other technique. There were few papers that investigated Milch’s technique and one paper compared Milch’s technique with Kocher’s technique. Each paper had different success rates for the techniques used. However, there were no papers that compared the scapular manipulation technique with Milch’s technique. Much recent research in this area has focused upon novel sedation techniques. It is possible that recent advances in procedural sedation could render the selection of manipulation technique a less important determinant of successful reduction. Future research in this area should therefore take into account the methods used for patient sedation.

Clinical Bottom Line

There is no evidence to support one technique over the other.