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

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 (Abduction) With the patient lying supine, the extended arm is abducted to 90 degrees whilst performing gentle vertical oscillating movements. At 90 degrees the arm is externally rotated. Reduction usually occurs at approximately 120 degrees of abduction (Maity 2012). The clinicians will have 0-5 minutes to attempt each methods and then move on to subsequent methods. The order of methods used to reduce the shoulder dislocation will be randomly applied to each patient. Participants may receive one, two or all three methods depending upon success/failure. For example, if Cunningham's (Method one) is unsuccessful, then FARES (method two) is applied. If FARES is unsuccessful, then Chair (method three) is applied.