A comparison of the efficacy of three methods of relocating the dislocated shoulder: Chair, FARES (FAst, REliable and Safe), and Cunningham's

INTERVENTION: This study will be conducted in a metropolitan emergency department in Sydney, NSW, Australia. The study will compare three methods of shoulder relocation that utilise different patient positioning and biomechanics to relocate the shoulder. An abduction and an adduction method will be compared with the chair method that utilises traction. The intervention with be performed by Emergency Department Nurse Practitioners, Physiotherapists and Medical Officers in the Fast track zone of the emergency department. Prior to commencement of the study each participating clinician will have face to face training to ensure the each method is performed according to the following descriptions. Chair method (Traction) The Chair Method is a traction technique that uses the back of a chair as a fulcrum whilst the clinician applies traction to the patient's arm. The patient sits sideways on the chair with their arm hanging over the backrest with a rolled towel placed under the axilla for padding. The clinician assumes a crouched position whilst holding the patient’s elbow and hand. Traction is gradually applied until reduction occurs (Guler, et al, 2015). This method was first described by Hippocrates in the 4th century BC (Mattick, 2000). Since then, the chair method has been described several times in the literature. The Cunningham Method (Adduction) The patient is seated with their elbow flexed and their hand resting on the clinician’s shoulder. The patient is encouraged to sit upright with their shoulders shrugged superiorly and posteriorly to retrovert the scapula and overcome the static obstruction of the glenoid rim. The clinician massages the bicep muscle to overcome the dynamic obstruction of the spasming musculature (Cunningham 2005). Fares Method CONDITION: Anterior Dislocated Shoulder; ; Anterior Dislocated Shoulder Emergency medicine ‐ Other emergency care Injuries and Accidents ‐ Other injuries and accidents Musculoskeletal ‐ Other muscular and skeletal disorders PRIMARY OUTCOME: The primary aim of this study is to compare three biomechanically different shoulder reduction methods to determine which method is superior. Superiority being defined as success on first attempt at reduction of the shoulder. Success or failure of shoulder reduction will be assessed by confirmation with x‐ray.[Immediately post‐shoulder reduction] SECONDARY OUTCOME: Duration from triage to reduction assessed by accessing patient medical record[At the time of intervention] Number of clinicians required for reduction assessed by accessing patient medical record[At the time of intervention] Number of iatrogenic injuries resulting from shoulder reduction assessed as a composite of shoulder x‐ray and clinical examination[Immediately post shoulder reduction ] Requirement for analgesia assessed by accessing patient medication chart[Assessed from time of emergency department presentation until the time of successful shoulder reduction.] INCLUSION CRITERIA: Anterior shoulder dislocations presenting to Nepean Emergency Department