title: Scapular manipulation for reduction of anterior shoulder dislocation without analgesia: results of a prospective study.
abstract: OBJECTIVE
  To the best of knowledge, this was the first study of scapular manipulation technique (SMT) in Asia. We conducted this prospective study to report our experiences of reducing anterior shoulder dislocation by SMT without analgesia in a large study group in Iran.
  
  
  METHODS
  Scapular manipulation technique was applied to 111 patients presenting with anterior shoulder dislocation to the ED of the largest teaching hospital in north-east of Iran between January 2009 and January 2010. Reduction was performed without medication and if unsuccessful, the second attempt was carried out with i.v. injection of midazolam. We also evaluated the pain experienced by the patients immediately after reduction attempt.
  
  
  RESULTS
  The study consisted of 112 dislocations (one patient had bilateral dislocation). We achieved a success rate of 87.5% without medication at the first attempt and 97.3% overall. In total, 98.2% of dislocations were reduced in less than 1 min. The success rate was significantly lower in the presence of greater tuberosity fractures and also in late presentations (>6 h after trauma). We showed a success rate of 100% in recurrent dislocations. Some 81.1% of the patients reported no pain or mild pain. No complications were observed.
  
  
  CONCLUSIONS
  The results of our study showed that SMT even without medication is a safe, rapid and relatively painless technique in reducing anterior shoulder dislocation in the ED that might reduce medical resource utilization and can be cost-effective.
authors.affiliation: Department of Emergency Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. pishbine@mums.ac.ir
authors.forename: Elham
authors.initials: E
authors.lastname: Pishbin
authors.forename: Ehsan
authors.initials: E
authors.lastname: Bolvardi
authors.forename: Koorosh
authors.initials: K
authors.lastname: Ahmadi
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007492:Iran; D008297:Male; D008349:Manipulation, Orthopedic / Q000379:methods*; D008875:Middle Aged; D009460:Neurologic Examination; D010147:Pain Measurement / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D011446:Prospective Studies; D011859:Radiography; D012008:Recurrence; D012017:Referral and Consultation; D012540:Scapula / Q000293:injuries*; D012783:Shoulder Dislocation / Q000000981:diagnostic imaging / Q000517:prevention & control* / Q000628:therapy; D016683:Supine Position; D013997:Time Factors