Fig. 128.1 Shoulder dislocation with loss of the normal deltoid bulge.

Fig. 128.2 (A) Anterior glenohumeral dislocation. Anteroposterior (AP) radiograph in a patient with shoulder pain after trauma shows inferior and medial displacement of the humeral head (black arrow) relative to the glenoid fossa (white arrow). The humeral head in anterior dislocation is usually pulled medially by muscles and is displaced inferiorly under the coracoid process. (B) Posterior glenohumeral dislocation. AP radiograph shows a patient with shoulder pain after a motorcycle accident. Note the wide glenohumeral joint (white arrows), the so-called rim sign, and loss of the normal half-moon overlap. The humerus is also internally rotated, causing the light bulb sign, where the lesser tuberosity (black arrow) projects medially. (C) Inferior glenohumeral dislocation (luxatio erecta humeri). AP radiograph of right shoulder showing inferior dislocation of glenohumeral joint.

Fig. 128.3 (A) Slow and gentle external rotation technique. (B) Slow and gentle adduction followed by gradual internal rotation will reduce the majority of dislocations that do not respond to external rotation alone.

Fig. 128.4 Scapular rotation technique.

Figure 128.5 Dr. Neil Cunningham demonstrates his technique for reducing shoulder dislocations. Seat the patient comfortably, as upright as possible, with shoulders relaxed. Supporting the affected arm, slowly and gently move the humerus into full adduction. Then gently massage the trapezius and deltoids.

Fig. 128.6 In the second part of the technique, Dr. Cunningham demonstrates how to gently massage the biceps at the midhumeral level. The next step is to ask the patient to shrug her shoulders, continuing the biceps massage. Wait for the patient to fully relax, and the humeral head will slip back into place.