Teaching Patients How to Reduce a Shoulder Dislocation: A Randomized Clinical Trial Comparing the Boss-Holzach-Matter...

Area of Science:

• Orthopedic Surgery
• Emergency Medicine
• Musculoskeletal Disorders

Background:

• Acute anterior shoulder dislocations are common injuries treated with various techniques.
• Surgeon preference often dictates the method used for shoulder reduction.
• Comparing patient-reported pain during self-reduction versus physician-assisted reduction is crucial for optimizing care.

Purpose of the Study:

• To compare the pain experienced by patients undergoing self-reduction versus physician-assisted reduction for acute anterior shoulder dislocations.
• To evaluate the efficacy and patient-reported outcomes of two distinct shoulder reduction techniques.

Main Methods:

• A randomized controlled trial was conducted in an emergency department involving patients aged 18-60 with acute anterior shoulder dislocations.
• Patients were randomized to either the Spaso technique (physician-guided) or the Boss-Holzach-Matter (BHM) self-reduction technique.
• Pain was assessed using a visual analogue scale (VAS), alongside reduction time and success rates.

Main Results:

• The BHM self-reduction group reported significantly lower pain scores (mean VAS 3.57) compared to the Spaso group (mean VAS 5.26) (p=0.047).
• No significant differences were observed in reduction time or success rates between the two groups.
• The study included 60 patients, with 30 in each treatment arm.

Conclusions:

• The Boss-Holzach-Matter self-reduction technique provides a less painful experience for patients with acute anterior shoulder dislocations compared to the Spaso technique.
• Self-reduction methods are as effective as physician-led techniques and are recommended as a first-line treatment, particularly for recurrent dislocations.