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.
The goal of Kocher’s method, which was worked out on cadavers in 1870, is to roll the greater trochanter of the humeral head on the glenoid rim. It might have been named the “shoulder rim roll.” Here are the steps:
1) Adduct the elbow all the way to get the greater trochanter right next to the glenoid rim.
2) Externally rotate to roll the greater trochanter on the glenoid rim.
3) Forward flex the shoulder (sagittal plane) to tip the humeral head back toward the socket.
4) 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 SHOULDER 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. Kocher himself in his article specified that this was for subcoracoid dislocations, and said “the more therefore the head has departed from the coracoid process toward the interior … the less can be expected from the method.”
-Make sure you fully adduct the elbow first.
-Avoid traction, which is what creates the need for sedation(Chitgopar Injury 2005).
-Avoid sedation. This is the best way to avoid too much force. Kocher’s method excluded the use of force. Perpendicular forces of opposing muscles can lead to fracture. If you get resistance, use another technique.
TAKE HOME POINTS:
-Kocher’s shoulder reduction was originally intended for subcoracoid dislocations, not for subglenoid.
-Do not use force with Kocher’s method.
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.