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The Milch Method of Easy Shoulder Reduction
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Posted on: 07/27/2006
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This study of shoulder dislocation in 75 patients confirms the safe and effective use of the Milch technique or maneuver. The Milch maneuver was named for Dr. Henry Milch in 1938. The examiner places the patient's arm in 90 degrees of abduction (arm moved away from the body) and 90 degrees of external rotation. This position will "reduce" or put the dislocated shoulder back in place.
The authors report this method of reduction is simple and doesn't require anesthesia or surgery. No force is needed because the position lines up the muscles, shoulder blade, and trunk to allow the humeral head to slide back into the shoulder socket. One person with training can do it. Medical residents, physician’s assistants, and emergency room staff should be trained to do the Milch technique.
Patients with recent (less than 24 hours) shoulder dislocation were included in this study. This was the first shoulder dislocation for 90 percent of the patients. X-rays were taken before and after the reduction. Bone fracture was present in 12 patients at the time of the dislocation.
All patients were reduced in the first try using the Milch method. Patients had pain relief right away. Results were the same for all patients no matter what the age or gender, or presence or absence of a fracture.
The Milch technique can be used to reduce a dislocated shoulder without medications or surgery. No pain is involved and one person can do it alone. In this study there were no complications such as nerve damage, displacement of bone fracture, new fracture, or injury to the blood vessels.
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References:
Daniel R. O'Connor, MD, PC, et al. Painless Reduction of Acute Anterior Shoulder Dislocations Without Anesthesia. In Orthopedics. June 2006. Vol. 29. No. 6. Pp. 528-532.
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