ShoulderDLxray

We commonly see patients with shoulder dislocations in the Emergency Department. There are a myriad of approaches in relocating the joint, which includes scapular rotation, Snowbird, and Kocher maneuvers.

I recently stumbled upon the Cunningham technique after hearing about it from Dr. Graham Walker (of MDCalc fame) on TheCentralLine.org.

The underlying concept of the Cunningham technique is that lengthening and relaxing the spasmed biceps muscle allows for the humeral head to spontaneously slide just over the glenoid rim and back into the glenohumeral joint socket.

I was a little skeptical when reading this technique, but the videos are quite convincing.

Tips

  • Build trust with the patient that you won’t hurt them.
  • Start with the patient’s elbow to his/her side.
  • The trick is to adequately position the scapula before you start. Move the anteverted scapula posteriorly by having the patient sit up straight, puff out chest, pull shoulders back, and relax as much as possible in that position.
  • Go slow.
  • Points of maximal massage: Trapezius, Deltoid and Biceps muscle along mid-shaft of humerus.
  • Warn the patient that when the humerus starts to move, it may feel odd but try to not to resist it.

While I haven’t used this technique before, I’ll be sure to give it a try. Physiologically, the procedure makes sense.

Michelle Lin, MD
ALiEM Editor-in-Chief
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
Michelle Lin, MD

@M_Lin

Professor of Emerg Med at UCSF-Zuckerberg San Francisco General. Founder of ALiEM @aliemteam #PostitPearls https://t.co/7v7cgJqNEn
Michelle Lin, MD