There are many ways to relocate a shoulder dislocation. Most of these ways require procedural sedation. What if the risks of procedural sedation outweigh the risks? What alternative maneuver can you try, which only requires parenteral pain medications +/- an intra-articular lidocaine?
Trick of the trade:
Legg Maneuver
Thanks for this guest contribution by Dr. Peter Lunny (EM-3) and Dr. Kevin Brody from Henry Ford Macomb (Michigan). This maneuver will also be featured in a future ACEP News "Tricks of the Trade" column.
An osteopathic physician, Dr. William J. Legg, in family practice invented the Legg Maneuver in the 1980’s. This technique incorporates motions, which serve to neutralize muscle groups, which typically resist shoulder relocation. Usually this procedure can be done without using procedural sedation.
Two practitioners are required to apply the Legg technique. The assistant stabilizes the unaffected shoulder while the physician stands at the side of the injured shoulder.
- Position the patient seated upright on a stretcher to minimize movement of the upper body.
- Have an assistant stabilize the patient's uninjured shoulder by applying slight downward and backward pressure to keep it against the stretcher. Stabilization must be maintained throughout the procedure.
- Abduct the injured arm to an angle 90° to the body. This minimizes the tension from the supraspinatus and deltoid muscles.
- Rotate the arm externally, such that the patient's palm is facing forward. This minimizes the tension from the infraspinatus and teres minor muscles.
- Flex the patient's elbow to a 90° angle. This minimizes the tension from the coracobrachialis and biceps muscles.
- Moves the injured extremity behind a coronal plane passing through the patient's occiput.
- Adduct the arm, fully flexing the elbow.
- Internally rotate the arm across the chest.
Reference
Dyck DD Jr, Porter NW, Dunbar BD. Legg reduction maneuver for patients with anterior shoulder dislocation. J Am Osteopath Assoc. 2008 Oct;108(10):571-3. PMID: 18948640
