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Saturday, March 18, 2000

Kocher's technique without traction reduces dislocation

In an acute setting, Kocher's technique used without traction is effective in rapidly reducing traumatic anterior shoulder dislocation without causing significant patient discomfort. These findings were presented in poster exhibit 420 by co-author Scott I. Berkenblit, MD, senior resident, Johns Hopkins Hospital, Baltimore, Md.

Twenty-eight patients with acute anterior shoulder dislocation presented to the Carlos Otis Stratton Mountain Clinic, Stratton, Vt., an acute-care facility at the base of a busy ski area during the 1995-96 ski season. All patients were seen within one hour of sustaining their injury. Following radiographic confirmation of the diagnosis, closed reduction was attempted, which consisted of slow, steady external rotation of the arm, followed by gentle forward flexion. If reduction had not yet been achieved, internal rotation was used. If these procedures were unsuccessful, alternative methods were attempted.

Kocher's method without axial traction resulted in successful reduction in 23 patients. The mean time required to achieve reduction was under five minutes and all but one was reduced in less than 10 minutes. Some patients expressed mild discomfort during the procedure, but only one of the successfully reduced patients required analgesia. The only neurovascular complication was a slight axillary hyperesthesia in one patient. Of the five unsuccessful reductions, two had fractures seen on the initial radiographs. No iatrogenic fractures occurred.

"Acute traumatic anterior glenohumeral dislocation is a common injury in downhill skiers," said Dr. Berkenblit. "Although Kocher's technique has been criticized for being excessively painful, it has been suggested that the pain. is due to humeral traction, which can worsen the spasm of the shoulder girdle muscles by stretching the capsule and soft tissues. Traction on the humerus was not mentioned in Kocher's original description of the technique."

Co-authors of the study with Dr. Berkenblit, from the Carlos Otis Stratton Clinic, are William R. MacAusland Jr., MD, vice president, and Mary Beth Hand, RN, executive director.

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Last modified 06/March/2000 by IS