ISSN 2689-8268 Volume 4

American Journal of Surgery and Clinical Case Reports

Research Article Open Access
Shoulder Dislocation Reduction by the Novel Prakash’s Method
Waqar M1, Ullah I2, Kabir S3*, Sanaullah4 and Arif khan M5
1
Department of orthopedic and spine surgery Hayatabad medical complex, Peshawar
2
Department of orthopedic and spine surgery Hayatabad medical complex, Peshawar
3
Department of orthopedic and spine surgery Hayatabad medical complex, Peshawar
4
Department of orthopedic and spine surgery Hayatabad medical complex, Peshawar
5
Head department of orthopedic and spine surgery Hayatabad medical complex, Peshawar

*
Corresponding author: Received: 19 Nov 2021 Copyright:
Accepted: 02 Dec 2021 ©2021 Kabir S. This is an open access article distribut-
Samir Kabir,
Department of orthopedic and spine surgery Published: 07 Dec 2021 ed under the terms of the Creative Commons Attribution
hayatabad medical complex Peshawar, J Short Name: AJSCCR License, which permits unrestricted use, distribution, and
Tel: +923008596400, build upon your work non-commercially.
E-mail: skkabir64@gmail.com
Citation:
Kabir S, Shoulder Dislocation Reduction by the Novel
Keywords:
Prakash’s Method. Ame J Surg Clin Case Rep.
Shoulder; Ligament; Prakash's Method; Relocation 2021; 4(1): 1-4

1. Abstract 2. Introduction
1.1. Objectives: The aim of this study is to evaluate the effective- Approximately 50-60% of dislocations of large joints involve the
ness of Prakash’s Method of relocation for dislocated shoulder. shoulder (glenohumeral) joint. Up to 90-96% of shoulder dislo-
1.2. Study Design: Descriptive Study. cations are anteroinferior [1, 2, 12, 17]. They cause pain, are of-
ten severe and require timely interventions to minimize discom-
1.3. Setting: Sports units of Hayatabad Medical Complex, Pesha-
fort and tissue damage3. Failure to reduce a dislocated shoulder
war.
successfully within the first 24 hours carries the risk that it will
1.4. Method: 30patients (30 Shoulders) were recruited for study, be impossible to achieve a stable closed reduction [4]. Because
all patients with signs symptoms of shoulder dislocation by clini- relaxation is a key factor for successful reduction, all dislocated
cal examination were subjected to anterior/ posterior shoulder ra- joints should ideally be reduced under general anesthesia with
diograph. And those diagnosed with anterior shoulder dislocations adequate analgesia and muscle relaxation [11]. In practice, most
were initially enrolled in the study. Reduction was performed us- departments attempt initial reduction in the emergency room with-
ing Prakash's method out sedation [5, 14]. A variety of techniques to reduce shoulder
1.5. Results: Prakash's method had success rate of 90.0% (n=27). dislocation has been described [7, 8, 15]. The key to a successful
In 10.0% (n=3) the reductions who failed were then reduced under relocation is a thorough understanding of the anatomy of both the
anesthesia using the Hippocratic method. 50.0% (n=15) patients allocated and the dislocated shoulder joint [6]. Commonly used
has mild pain, 36.7% (n=11) has moderate pain, and 13.3% (n=4) reposition or relocation techniques often involve traction and/ or
has severe pain during the procedure. All patients having mild and leverage. These techniques have high success rates but may be
moderate pain were reduced successfully in the first attempt. 4 pa- painful and time-consuming. They may also cause complications
tients who has severe pain out of which 1 patient was reduced suc- [2, 3, 16]. Ideal reduction methods should be quick, effective, and
cessfully and 3 patients were reduced by the Hippocratic method as painless as possible for patients; and they should not cause iat-
using anesthesia. The reduction time was ranging from 180-300 rogenic complication [9, 11, 13].
seconds with a mean of 216±85 seconds. no complication occurred The Prakash new method of reducing anterior shoulder disloca-
during the procedure. tion which requires minimum assistance, has a high success rate,
1.6. Conclusion: Prakash Method of shoulder relocation for acute- requires no anesthesia, and is not time-consuming, has less pain,
ly dislocated shoulder is an effective method. is safe, or has minimal complications [9, 10]. Accordingly, this

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study aims to evaluate reduction success, pain intensity while re- 5. Results
ducing shoulder, the timing of the procedure, and complications This study was performed based on the data of 30 patients. The
of the maneuver while reducing shoulder dislocation by Prakash's mean age of the patients was 36.46±11.58 years. Among them,
method. 83.3% (n =25) were male and 16.7% (n = 5) were female. While
3. Method dislocation occurred on the right shoulder in 63.3% (n=19) and
This descriptive study was carried out at Rahman medical and in 36.7% (n=11) on the left side. All the patients have dislocation
surgical center district Buner from June 2017 to December 2019. for the first time. Those patients who had a fracture, polytrauma,
All patients with signs symptoms of shoulder dislocation by clin- or unconsciousness for more than 1 week were excluded from the
ical examination were subjected to anterior/ posterior shoulder study. Reduction was performed using Prakash's method. the suc-
radiograph. And those diagnosed with anterior shoulder disloca- cess rate was 90.0% (n=27). In 10.0% (n=3) the reductions who
tions were initially enrolled in the study. The demographic data failed were then reduced under anesthesia using the Hippocratic
including age, gender, history of previous dislocation, time since method. 50.0% (n=15) patients has mild pain, 36.7% (n=11) has
dislocation, and associated fracture were noted in the patient's case moderate pain, and 13.3% (n=4) has severe pain during the pro-
sheet. All those patients with a history of previous dislocation, cedure. All patients having mild and moderate pain were reduced
polytrauma, unconscious patients, those presenting more than a successfully in the first attempt. 4 patients who has severe pain
week after dislocation, fracture dislocations of the shoulder were out of which 1 patient was reduced successfully and 3 patients
excluded from the study. After explaining the procedure consent were reduced by the Hippocratic method using anesthesia. The re-
was taken from all patients. The patients were counselled about the duction time was ranging from 180-300 seconds with a mean of
procedure and the visual analogue scale for pain documentation. 216±85 seconds. no complication occurred during the procedure
A total of 36 patients were initially enrolled in the study 6 patients (Table 2).
were excluded from the study not meeting the inclusion criteria. Table 2: Demographic, and reduction-related data.
No anesthesia or sedation was given to the patients. After the pro- Age (years) Mean+SS 36.46±11.58
cedure reduction success, pain during the procedure, time taken by
Gender N (%)  
the procedure, and complications were noted on the patient case
Male   25 (83.3)
sheet. Pain was recorded by a 10 points visual analogue scale (Ta-
ble 1) The results were analyzed in terms of reduction success, Female   5 (16.7)
pain during the procedure, and time taken by the procedure. A sin- Lesion side N (%)  
gle attempt was allowed if more than one attempt or anesthesia Right   19 (63.3)
was needed that was considered as treatment failure. The results Left   11 (36.7)
were analyzed using SPSS version 20. Reduction success rate N (%) 27 (90.0)
Table 1: Visual analogue scale. Reduction failure rate N (%) 3 (10.0)
Pain intensity N (%)  
SCALE PAIN INTENSITY
Mild   15 (50.0)
0 NO PAIN
Moderate   11 (36.7)
1-3 MILD PAIN
Severe   4 (13.3)
4-6 MODERATE PAIN
Reduction time (seconds) Mean+SS 216±85
7-10 SEVERVE PAIN

6. Discussion
4. Reduction Technique
Glen humeral dislocations commonly present to the Emergency
The patients are made to sit on a chair with the back supported to
Department (ED) and are generally due to sports-related trauma,
fix the scapula against the chair. The surgeon holds the patient's
falls, motor vehicle accidents, and, rarely, seizures [18]. The com-
wrist with one hand and elbow with the other. Gradual external
monly used anterior glen humeral dislocation repositioning tech-
rotation of the shoulder is done in the position of deformity until
niques using traction and/ or leverage inflict pain, are time-con-
its parallel to the coronal plane without any abduction or adduction
suming, and are not always effective [3]. Many methods have been
of the shoulder. The external rotation force is maintained for more
advocated for reduction with varying success rates and complica-
than a minute and try to engage the patient in some talk to reduce
tions. In general, success rates of about 70-90% have been report-
apprehension. While sustaining external rotation the arm is gradu-
ed regardless of the technique. Some dislocations may require the
ally adducted until the elbow comes over the body then internally
use of more than one method1. Uncooperative patients and first-
rotate the arm so that the hand touches the opposite shoulder. The
time dislocates can make closed reduction quite difficult [5]. The
shoulder reduces without any clunk or sound.
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choice of reduction maneuver depends upon the surgeon or treat- scoring during the procedure was that 60 patients has mild to mod-
ing physicians and the environment or place of work. However, in erate pain while one patient has severe pain. Pain scoring was done
general, a relatively painless maneuver does not require sedation using the visual analogue scale system for pain scoring. The reduc-
or anesthesia, without the need of an assistant, with no or minimal tion time was ranging from 90 seconds to 200 seconds with a mean
complications that can be easily reproducible is preferred [11]. In of 130.5±25.8 seconds. They reported no complications related to
2016 Prakash's method of shoulder dislocation was introduced for the procedure [11]. T. kuru et al. in 2020 using Prakash’s method
the reduction of ant shoulder dislocation and later published in of shoulder dislocation reduced 18 shoulders out of 19 with a suc-
2018 [10]. because of its high success rate, minimal complication, cess rate of 94.7% without any complication. only one patient was
no assistant requirements, no anesthesia requirements, minimal then reduced using the Hippocratic method. The mean reduction
pain during the procedure, and minimal time requirements, dif- time was 243±38 seconds9. In our study, we included 30 patients
ferent researchers have worked on it with different success rates. with shoulder dislocation using Prakash's method. Out of which 27
In 2018 of original Prakash's study, who managed 147 patients patients were reduced successfully having a success rate of 90.0%
with anterior shoulder dislocation. He mentioned that out of 147 only 3 patients were unable to reduce which were reduced by the
patients there was no pain in 116 patients, 30 patients had mild to Hippocratic method leading to a failure rate of 10.0% no compli-
moderate pain while one patient has severe pain during the pro- cation was reported related to the procedure. pain scoring during
cedure. The reason that majority of patients has no pain during the procedure was that 15 patients has mild pain, 11 has moderate
the procedure was that all the patients were prisoners with a high pain and 4 has severe pain. The reduction tie was ranging between
threshold for pain. The reduction was successful in all patients 180 seconds to 300 seconds with a mean of 216±85 seconds. (Ta-
without any complications [10]. In 2019 a study by R. Anjum et al. ble 2)
using Prakash's maneuver of shoulder dislocation for ant shoulder The limitation of the study was the limited no of patients. Large-
dislocation reported a success rate of 95.08% the study was done scale studies are required to study the various parameters of
on 61 patients out of which 58 patients were reduced with the first Prakash's method including success, pain intensity, reduction tim-
attempt having a success rate of 95.08%. the remaining 3 patients ing, and complication. Because of its easy use, Prakash's method
were relocated by the same maneuver in the second attempt. Pain is a novel method and should be adopted by all orthopedics and
trauma surgeons in the ER for ant shoulder dislocation. (Table 3)
Table 3.

Authors references Prakash et al. R. Anjum et al. T. kuru et al. Present study
Year of publication 2018 2019 2020 2020
No of patients 147 61 19 30
Success rate no/% 147/100 58/95.08 18/94.7 27/90.0
Pain scoring no/%        
No pain 116/78.91 0 - 0
Mild to Mod pain 30/20.40 60/98.36 - 26/86.66
Severe pain 1/.68 1/1.63 - 4/13.33
Reduction time        
Mean (seconds) - 130.5±25.8 243±38 216±85

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