Reduction of shoulder dislocation: are communication and adequate relaxation more important than technique?

Various techniques have been proposed to reduce anterior shoulder dislocation in the emergency department (ED). The superiority of one approach over another has yet to be established. The key role of good muscle relaxation in successful reduction by any method has been recognized in the literature,1,2 but instructions on how to best achieve it are lacking. Usually, a pharmacologic solution is proposed,3 which most commonly involves moderate to deep intravenous sedation. Taking a patient close to a level of deep sedation will achieve good muscle relaxation and expedite reduction. It carries the risk of hypoventilation and loss of patency of the airway. One must be confident in managing these complications. Intra-articular injection of a local anesthetic is a less risky alternative, albeit one that patients find less appealing.4,5