Although the literature is silent on the number of attempted reductions, it is probably reasonable to attempt this method up to three times, especially if the patient is having difficulty relaxing or following instructions. Patients and sometimes physicians have the idea that a violent maneuver is required to reduce a dislocated shoulder, but in fact the opposite is true. The shoulder wants to be in alignment. After overcoming some muscle spasm, it will usually spontaneously reduce as this maneuver allows. Counter to what might seem intuitive, pulling the anteriorly dislocated shoulder farther anterior actually permits disengagement of the Hill-Sachs lesion, which can lock on the anterior glenoid.
Spontaneous reduction follows.
Finally, one should consider postreduction evaluation in either a physician's office or emergency department. This is especially important if it is the patient's first dislocation. Dr Joy is an associate professor in the department of family and preventive medicine and a team physician at the University of Utah in Salt Lake City. The McGraw-Hill Companies.