Painless reduction of acute anterior shoulder dislocations without anesthesia

In 1938, Dr. Henry Milch described a maneuver for the reduction of acute anterior shoulder dislocations consisting of shoulder abduction and external rotation with "pulsion" of the humeral head. Although many methods may be used to reduce the dislocated glenohumeral joint, the Milch technique is unique because of its gentle, effective, and relatively painless nature. This article studied the effectiveness of this technique on 76 consecutive acute anterior shoulder dislocations in 75 patients seen in our institution's two campuses over an 18 month period. Twelve shoulders had concomitant fractures of the greater tuberosity. All 76 shoulders were reduced on the first attempt. No anesthesia was used, and no complications were reported from the reduction maneuver. The Milch method is an ideal first line treatment for all acute anterior shoulder dislocations including those associated with fracture of the greater tuberosity.