Self-reduction techniques taught via smartphone are effective for anterior shoulder dislocation: prospective randomized study

Purpose: To prospectively compare the effectiveness of three methods for self-assisted shoulder reduction demonstrated using a smartphone video link. Background: Anterior shoulder dislocation is very common among young adults. Patients often seek medical assistance in the emergency department to reduce their shoulder. Many techniques for shoulder reduction had been described, some of which do not require professional assistance and can be performed by patients themselves. Methods: Patients admitted with anterior shoulder dislocation were randomized to either the Stimson, Milch or the Boss–Holtzach–Matter technique. Each patient was given a link to watch a short instructional video on his smartphone and instructed to attempt self-reduction. Success of the reduction, pain level, patient satisfaction and complications were recorded. Results: The study cohort consisted of 58 patients (mean age was 31.6 (18–66, median = 27), 82% males, 88% right hand dominant). Success rate using Boss–Holtzach–Matter (10 of 19, 53%) and self-assisted Milch (11 of 20, 55%) were significantly higher than with the self-assisted Stimson method (3 of 19, 16%), p < 0.05. Pain levels improved from 8.4 (2–10) to 3.1 (0–10) following the reduction. Patient subjective satisfaction from the reduction attempt was 6.7 (0–10). No complications were observed. Conclusion: Both the Self-assisted Milch and the Boss–Holtzach–Matter techniques are ideal for reduction of anterior shoulder dislocation without medical assistance. Both methods can be successfully performed without assistance or previous education and taught using an instructional video. Level of evidence: Level II.