Managing Anterior Shoulder Dislocation Gregory W. Hendey, MD  Annals of Emergency Medicine  Volume 67, Issue 1, Pages 76-80 (January 2016) DOI: 10.1016/j.annemergmed.2015.07.496 Copyright © 2015 American College of Emergency Physicians Terms and Conditions

Figure 1 External rotation, with patient in the supine position. Note the gentle traction (small arrow) and stabilization of the patient’s elbow in an adducted position while external rotation is applied by holding the patient’s wrist (large arrow). Annals of Emergency Medicine 2016 67, 76-80DOI: (10.1016/j.annemergmed.2015.07.496) Copyright © 2015 American College of Emergency Physicians Terms and Conditions

Figure 2 Progressing from external rotation to the Milch technique. While traction is maintained, the patient’s arm is slowly taken through a wide arc, from the patient’s side, into a fully overhead position. Annals of Emergency Medicine 2016 67, 76-80DOI: (10.1016/j.annemergmed.2015.07.496) Copyright © 2015 American College of Emergency Physicians Terms and Conditions

Figure 3 Scapular manipulation combined with Stimson. With the patient in a prone position, downward traction is applied (large arrow). Placing his thumbs along the inferolateral border of the scapula, the clinician pushes the scapula in an upward, medial direction, toward the base of the patient’s neck (small arrow). Annals of Emergency Medicine 2016 67, 76-80DOI: (10.1016/j.annemergmed.2015.07.496) Copyright © 2015 American College of Emergency Physicians Terms and Conditions

Figure 4 Cunningham technique, facing the patient diagonally. Note the minimal traction by the clinician’s left hand while he massages with the right, instructing the patient to relax and pull back the shoulders. Annals of Emergency Medicine 2016 67, 76-80DOI: (10.1016/j.annemergmed.2015.07.496) Copyright © 2015 American College of Emergency Physicians Terms and Conditions

Figure 5 Traction-countertraction. Sheets around the patient’s elbow and chest wall allow the clinicians to use their own body weight while spreading the forces over a larger surface area. Annals of Emergency Medicine 2016 67, 76-80DOI: (10.1016/j.annemergmed.2015.07.496) Copyright © 2015 American College of Emergency Physicians Terms and Conditions