title: Efficacy of gentle traction, abduction and external rotation maneuver under sedative-free for reduction of acute anterior shoulder dislocation: retrospective comparative study.
abstract: BACKGROUND
  Reduction technique of acute anterior shoulder dislocation is always performed under sedation or general anesthesia in order to permit successful reduction such as traction counter-traction (TCT). However, the patients take risks of sedation or anesthesia. There are several techniques of reduction that reduce the dislocation without using sedation or anesthesia such as Milch technique, gentle traction, abduction and external rotation (TAE) technique and scapular manipulation. In the present study, the authors compared efficacy of reduction of acute anterior shoulder dislocation by using TAE without sedation and TCT techniques under conscious sedation.
  
  
  OBJECTIVE
  To compare efficacy of TAE without sedation and TCT techniques under conscious sedation for reduction of acute anterior shoulder dislocation.
  
  
  METHODS
  Between 2001 and 2010, the authors reviewed medical records and radiographs of 76 patients who sustained one or more episodes of acute anterior shoulder dislocation and divided into two groups. Group 1 used the technique of TAE without sedation. Group 2 used the technique of TCT under conscious sedation. Group 1 and 2 consisted of 32 and 44 patients, 24 and 33 males, eight and 11 females, average age 39.13 (17-71) and 34.77 (18-76) years old, 24 and 34 right sides, eight and 10 left sides, 21 and 24 from sport injuries and 10 and 18 non-sport injuries respectively. Successful reduction, post-reduction complication and patients 'satisfaction score of 0 to 10 of both groups were evaluated and p < or = 0.05 were considered for statistical significant differences.
  
  
  RESULTS
  The successful reduction of group 1, 2 were 90.63% (29/32) and 100% (44/44) with 95% Confidence interval 74.98 to 98.02% and 93.42 to 100% respectively. The statistical analysis showed no significant difference of both groups (p = 0.071). There was no post-reduction complication of both groups. The patients' satisfaction score of group 1, 2 were 9.38 (8-10) and 7.94 (3-10). The statistical analysis showed patients' satisfaction score of group 1 were significantly higher than group 2 (p = 0.007).
  
  
  CONCLUSIONS
  TAE technique under sedative-free for reduction of acute anterior shoulder dislocation is effective, simple, and safe.
authors.affiliation: Department of Orthopedics Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Thos
authors.initials: T
authors.lastname: Harnroongroj
authors.forename: Jumphon
authors.initials: J
authors.lastname: Wangphanich
authors.forename: Thossart
authors.initials: T
authors.lastname: Harnroongroj
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016292:Procedural Sedation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D026741:Physical Therapy Modalities; D012189:Retrospective Studies; D012399:Rotation; D012783:Shoulder Dislocation / Q000628:therapy*; D014143:Traction; D055815:Young Adult