Spoon Feed
The Boss-Holzach-Matter (self-reduction) technique was less painful than the physician-driven Spaso technique and just as successful and efficient.
Why does this matter?
There are several methods to reduce anterior shoulder dislocation. We did a video several years back with a few. But which one is least painful? That’s what this RCT tackled.
Self-reduction like a Boss!
This was a RCT comparing the Boss-Holzach-Matter (BHM, aka Davos) technique to the Spaso technique. There were 30 in each group. The BHM technique was significantly less painful than the Spaso technique, 3.57 vs 5.26, respectively on a visual analog pain scale. They were statistically equivalent in time to reduction (BHM 90 seconds; Spaso 105 seconds) and in success rate (BHM 77%; Spaso 67%). Authors recommend BHM as first line, especially for recurrent dislocations. And they recommend teaching patients to do it at home.
Image adapted from and quote from cited article: “During the Boss-Holzach-Matter technique, the patient sits on the examination table with the lower limb straight. The knee on the same side as the dislocated shoulder is then flexed to 90, and the patient laces the fingers around this knee. The patient is asked to lean back, while hyperextending the neck, until the arms are fully extended. Simultaneously, the patient shrugs the shoulders anteriorly, generating anteversion of the scapula.”
Source
Teaching Patients How to Reduce a Shoulder Dislocation: A Randomized Clinical Trial Comparing the Boss-Holzach-Matter Self-Assisted Technique and the Spaso Method. J Bone Joint Surg Am. 2018 Mar 7;100(5):375-380. doi: 10.2106/JBJS.17.00687.
Editorial: You Can Do It! Directed Self-Reduction of an Anterior Shoulder Dislocation Works: Commentary on an article by F.A. Marcano-Fernández, MD, MSc, et al.: “Teaching Patients How to Reduce a Shoulder Dislocation. A Randomized Clinical Trial Comparing the Boss-Holzach-Matter Self-Assisted Technique and the Spaso Method”. J Bone Joint Surg Am. 2018 Mar 7;100(5):e32. doi: 10.2106/JBJS.17.01401.
Another Spoonful
- JBJS did a great video summary of this paper on YouTube.
- ICYMI in the link above, Larry Mellick did a video of the Davos (BHM) technique on YouTube as well.
Peer reviewed by Thomas Davis
