There are probably too many techniques for anterior shoulder reduction and too many eponyms. We need to transition to an anatomical approach but we are not there yet. For a head start, let’s think about the two most common types of anterior shoulder dislocation we see.
SUBCORACOID VS SUBGLENOID
Subcoracoid is the most common, found in 70% of anterior dislocations. This is where the humeral head rests just below the coracoid process. The subglenoid location, with the humeral head inferior to the glenoid, is found in 30% of anterior dislocations.
ONLY USE SUBCORACOID TECHNIQUES ON SUBCORACOID DISLOCATIONS
The Kocher technique, one of the oldest and most popular techniques, was developed for the subcoracoid anterior dislocation. Review Neil Cunningham’s resources at shoulderdislocation.net for insight on this, as well as his translation of the original Kocher article.
TROCHANTERIC RIM ROLL
Do the eponyms confuse you? Think of Kocher’s method as the “trochanteric rim roll.” First adduct the elbow all the way to get the greater trochanter right next to the glenoid rim. Then externally rotate to roll the greater trochanter on the glenoid rim. Then forward flex the shoulder (saggital plane) to tip the humeral head back toward the socket. Finally, internally rotate to complete the reduction.
“Pressing the arm bent at the elbow towards the body, turning outward until resistance is felt, lifting of the outwardly rotated upper arm in the sagittal plane as far as possible, and finally slowly turning it inward” (translation by Cunningham)
DON’T USE THE TROCHANTERIC RIM ROLL IF YOU AREN’T ROLLING ON THE RIM
The subglenoid dislocation will not be resolved with the Kocher technique because the external rotation phase will not latch onto anything.
-Avoid traction, which is what creates the need for sedation(Chitgopar Injury 2005).
-Make sure you fully adduct the elbow first.
Note: I use the term “trochanteric rim roll” because it conveys the mechanism of the procedure. This is more of a teaching device and is not standard terminology.
TAKE HOME POINTS:
-Kocher’s “trochanteric rim roll” was originally intended for subcoracoid dislocations, not for subglenoid.
shoulderdislocation.net (see the lectures and translation of the original Kocher article)
Chitgopkar SD, Khan M. Painless reduction of anterior shoulder dislocation by Kocher’s method. Injury. 2005;36:1182-4.