A comparison of the scapular manipulation and Kocher's technique for acute anterior dislocation of the shoulder

Abstract

Objectives: The aim of the present study was to compare the scapular manipulation technique and the Kocher's method in terms of efficacy, safety, and the intensity of pain felt by the patient in the reduction of acute anterior shoulder dislocation.

Patients and methods: Between July 2009 and January 2010, a total of 64 patients with acute traumatic anterior dislocation of the shoulder were evaluated. Of the 64 patients assessed, three patients were excluded because of cardiopulmonary problems. The remaining 61 patients (41 males, 20 females; mean age 42 +/- 18.5 years; range 17 to 87 years) were enrolled in this prospective randomized study and devided into two groups. Thirty-one patients were treated with scapular manipulation (group 1) and 30 patients were treated by the Kocher's method (group 2). A procedural sedation/analgesia was applied before the reduction to meet the target sedation score of 1 or 2 according to the Ramsay sedation scale. A visual analog scale was used to determine the intensity of the pain felt by the patients during reduction.

Results: Reduction was successfully achieved with the scapular manipulation method in 96.7% of the patients, and with the Kocher's method in 93.3% (p>0.05). The degree of pain experienced by group 1 was lower than group 2 (p<0.01).

Conclusion: Both scapular manipulation and Kocher's techniques are successful and reliable methods when procedural sedation/analgesia is used routinely. Scapular manipulation is a less painful method of reduction of an anterior shoulder dislocation in comparison with the Kocher's technique.