An anterior shoulder dislocation is reduced by applying specific combinations of traction, rotation, and muscle relaxation to guide the humeral head back into the socket. Several well-established techniques exist, ranging from methods a clinician performs in an emergency department to self-assisted maneuvers a patient can learn for use in remote settings. The right approach depends on the situation, available help, and whether sedation is an option.
What Happens During Reduction
When the shoulder dislocates anteriorly, the ball of the upper arm bone (humerus) slips forward out of the shallow socket. The surrounding muscles, especially the deltoid and biceps, go into spasm to protect the joint, which locks the bone in its displaced position. Every reduction technique works by overcoming that muscle spasm, either through direct relaxation, positioning that gives the muscles a mechanical disadvantage, or steady traction that fatigues them enough for the bone to slide home.
Before reduction, imaging is sometimes needed to rule out a fracture. Clinical guidelines recommend X-rays for anyone over 40, anyone experiencing a first-time dislocation, and younger patients whose injury involved a car accident, a fall from standing height, a fight, or a sports collision. Patients with a known history of repeat dislocations and a low-energy mechanism may not need imaging before the joint is put back.
The Cunningham Technique
The Cunningham technique stands out because it uses no forceful pulling or leveraging. Instead, it relies entirely on targeted massage to release the muscles holding the joint out of place. You sit upright with your arm at your side, elbow bent. A provider then massages three specific muscle groups in sequence: the trapezius (the large muscle between your neck and shoulder), the deltoid (the cap of the shoulder), and the biceps. The goal is to coax each muscle out of spasm so the humeral head can drop back into the socket on its own.
Because the technique avoids repositioning the arm into painful positions, it typically causes less discomfort than traditional methods and can sometimes be performed without sedation. It works best when the patient can genuinely relax, which means staying calm and breathing steadily while the provider works through each muscle group.
External Rotation (Hennepin) Method
This technique is commonly used in emergency departments because it’s gentle and straightforward. You sit or lie on your back with your elbow bent to 90 degrees and tucked against your side. The provider then slowly rotates your forearm outward, like opening a door, pausing whenever you feel increased pain or resistance. The rotation is performed extremely slowly, sometimes taking several minutes, to let the muscles gradually release. Once the arm reaches full external rotation, the humeral head typically slips back into place with a subtle clunk.
The Milch Maneuver
The Milch technique uses a combination of abduction (raising the arm out to the side) and external rotation. You lie on your back while a provider gradually lifts your arm overhead and rotates it outward. Once the arm is fully abducted, gentle pressure is applied to the humeral head to nudge it back into the socket. In a comparative study, the Milch technique achieved reduction in an average of about 4.7 minutes, roughly half the time of the Stimson method.
The Stimson Technique
For the Stimson method, you lie face down on a raised bed with your affected arm hanging straight down over the edge. A weight of about five pounds is attached to the wrist or held in the hand, providing steady downward traction. Gravity and the weight slowly fatigue the spasming muscles until the joint reduces, which typically takes around 9 minutes. It requires patience and a bed high enough to let the arm dangle freely, but it’s considered low-risk because it uses minimal force.
Self-Reduction: The Boss-Holzach-Matter Technique
For people with a history of repeat dislocations who spend time in remote or wilderness settings, the Boss-Holzach-Matter technique (also called the Davos or Aronen technique) allows you to reduce the shoulder yourself without assistance. Here’s how it works:
- Sit on a firm surface and bend the knee on the same side as the injured shoulder to 90 degrees, placing your foot flat.
- Interlock your fingers around the front of that knee, cradling it with both hands.
- Lean back slowly with your neck extended, letting your body weight straighten your arms completely. This creates steady traction along the axis of the arm.
- Shrug your shoulders forward while maintaining that traction. This tips the shoulder blade forward and helps the humeral head find its way back into the socket.
In a randomized clinical trial, no complications were recorded with this method. Researchers specifically recommended it as a practical skill for younger patients at high risk of repeat dislocation, since performing it quickly in the field reduces pain, anxiety, and the time spent with the joint out of place.
Nerve Injury: What to Watch For
The axillary nerve runs directly around the neck of the humerus, which puts it at risk during any dislocation. Nerve injuries occur in roughly 16% to 48% of dislocations, with the axillary nerve being the most commonly affected. People over 60 face the highest risk. The classic screening test checks for numbness over the “regimental badge” area, the patch of skin on the outer upper arm where a military insignia would sit. However, normal sensation in that area doesn’t completely rule out nerve damage because the nerve splits into separate branches for sensation and movement.
Most of these injuries are mild (a temporary conduction block from swelling and compression) and recover fully within about 12 weeks. More severe injuries involve actual damage to the nerve fibers and take longer, sometimes requiring surgical evaluation if strength doesn’t return.
Structural Damage After Dislocation
Dislocation almost always causes some degree of structural injury to the joint. A systematic review and meta-analysis found that 71% of first-time dislocations produce a Hill-Sachs lesion, a dent in the back of the humeral head where it impacts the rim of the socket on its way out. About 59% also develop a Bankart lesion, a tear of the cartilage rim (labrum) at the front of the socket. With repeat dislocations, those numbers climb to 85% and 66%, respectively. These lesions are a major reason the shoulder becomes progressively easier to dislocate over time.
Post-Reduction Immobilization
After a successful reduction, the shoulder is typically placed in a sling. The traditional approach has been to immobilize for three or more weeks, but research suggests that longer immobilization doesn’t actually lower recurrence rates. In patients under 30, studies found no difference in re-dislocation rates whether the sling was worn for less than one week or more than three weeks.
There has been interest in immobilizing the shoulder in external rotation (arm rotated outward) rather than the traditional internal rotation (arm across the body in a standard sling). The rationale is that external rotation holds the torn labrum against the socket rim, theoretically allowing it to heal in a better position. Some data show a trend toward fewer recurrences with external rotation (25% vs. 40%), but the difference has not been statistically significant in larger studies.
Recurrence Risk by Age
Age at the time of first dislocation is the single strongest predictor of whether it will happen again. In a large study following patients for an average of 11 years, those aged 16 to 20 at their first dislocation had a 47.1% recurrence rate with non-surgical management. Patients 15 and under were close behind at 38.8%, with 47% of that group experiencing three or more instability events. By contrast, only 12% of patients aged 31 to 40 had three or more events.
This age-dependent pattern is why surgical stabilization is often discussed early for young, active patients after even a first dislocation, particularly athletes in overhead or contact sports. For older patients, the recurrence risk is lower, but the chance of a rotator cuff tear during the dislocation itself goes up significantly with age.