The Stimson technique is a gravity-assisted method for relocating an anteriorly dislocated shoulder, performed with the patient lying face down on a raised surface while weight or manual traction pulls the affected arm toward the floor. Developed as one of the gentler approaches to shoulder reduction, it relies on sustained, low-force traction rather than forceful manipulation. Despite its appealing simplicity, its track record in clinical trials is mixed, and understanding when it works well and when it falls short matters for both clinicians and patients who may encounter it in an emergency department or even a backcountry setting.
How the Technique Works
The setup is straightforward. You lie prone on a bed or table high enough that your affected arm can hang freely off the edge. A clinician then applies downward traction to the arm, either by hand or by strapping weights to the wrist. The traction is maintained for roughly 10 to 20 minutes. During that time, the muscles around the shoulder gradually fatigue and relax, and gravity does most of the work. Once enough muscle spasm has released, the head of the upper arm bone slips back into the shoulder socket on its own or with minimal guidance.1Turkish Journal of Emergency Medicine. A systematic and technical guide on how to reduce a shoulder dislocation
The key biomechanical principle is that prone positioning angles the shoulder joint so that gravity naturally pulls the humeral head toward the glenoid (the shallow cup it normally sits in). The weight hanging from the arm creates steady longitudinal traction along the axis of the humerus. This combination of positioning and low-force traction distinguishes the Stimson approach from techniques that use leverage or quick rotational movements. In theory, the gentleness of the method should mean less pain and a lower risk of causing additional injury during the reduction.
Success Rates in Practice
Theory and practice diverge here. In a prospective randomized trial comparing the Stimson technique with the Milch technique (which uses overhead arm abduction and gentle external rotation), the Stimson method succeeded on the first attempt in only about 28% of cases, compared to roughly 83% for the Milch approach. Reduction also took longer with the Stimson method, averaging close to 9 minutes versus under 5 minutes for the Milch technique.2PubMed. Milch versus Stimson technique for nonsedated reduction of anterior shoulder dislocation: a prospective randomized trial and analysis of factors affecting success That 28% first-attempt success rate is strikingly low and has made some emergency physicians skeptical of the Stimson technique as a standalone method.
A few things likely contribute to those underwhelming numbers. The Stimson technique depends heavily on the patient being able to relax their shoulder muscles. If you are in significant pain and your body is guarding the injury with involuntary muscle spasm, 10 to 20 minutes of lying face down with a weight on your wrist may not be enough to overcome that tension. Patient anxiety, inadequate pain control, and muscular body habitus can all work against the method. The trial mentioned above used only oral analgesics, which may have been insufficient for many patients to achieve the level of relaxation the technique demands.
It is worth noting that success rates for any shoulder reduction technique vary widely depending on the study population, pain management protocol, and operator experience. A separate study comparing four different reduction methods (the Chair technique, Kocher, Spaso, and Matsen methods) found that all four achieved success rates above 90%, with no statistically significant difference among them.3Journal of Orthopaedic Surgery and Research. Comparison of four different reduction methods for anterior dislocation of the shoulder The Stimson technique was not included in that particular comparison, but the study illustrates that with adequate analgesia and sedation, most well-executed techniques work. The implication is that the Stimson method’s poor showing in some trials may reflect its reliance on muscle relaxation that patients simply cannot achieve without stronger pain control.
Pain Management Makes or Breaks the Technique
This is the single most important practical point about the Stimson technique. When patients receive adequate analgesia, the method works much more reliably. One approach that pairs naturally with it is intra-articular lidocaine, where a local anesthetic is injected directly into the shoulder joint. A randomized study found that intra-articular lidocaine combined with the Stimson technique was both safe and effective for reducing acute shoulder dislocations in the emergency department, and it required less money, time, and nursing resources than intravenous sedation paired with the same technique.4PubMed. Comparison of intra-articular lidocaine and intravenous sedation for reduction of shoulder dislocations: a randomized, prospective study
The intra-articular lidocaine approach has a practical advantage that goes beyond cost savings. Intravenous sedation typically requires the patient to have fasted (the “nil by mouth” rule), the presence of an anesthesiologist or a sedation-trained physician, monitoring equipment, and recovery time. Intra-articular lidocaine sidesteps all of that. The injection numbs the joint directly, reducing spasm enough for gravity and traction to do their work, without putting the patient into a sedated state.5Medical Journal of Shree Birendra Hospital. Reduction of Acute Anterior Shoulder Dislocation Using Intraarticular Lidocaine(IAL) and Stimson’s Technique For busy emergency departments where sedation resources are stretched thin or where the patient has just eaten, the combination of intra-articular lidocaine and the Stimson technique offers a practical workaround.
Modified Versions and Traction Devices
The classic Stimson technique has a logistical limitation: someone has to hold the weights or strap them to the patient’s wrist and then wait. Clinicians do not always have the luxury of standing beside a patient for 15 to 20 minutes in a busy emergency department. This has led to several modifications designed to make the technique more practical and reproducible.
One approach involves purpose-built traction devices that attach to the patient’s arm and provide continuous, controlled longitudinal traction while the patient lies prone. These devices free up the clinician’s hands, allowing them to perform additional maneuvers like scapular manipulation (gently pushing on the shoulder blade to help guide the humeral head back into place) at the same time.6PubMed Central. Novel Traction Device for Reducing Anterior Shoulder Dislocations Using the Modified Stimson Technique The portability and simplicity of such devices are selling points, and one study of traction devices used with the Stimson method reported a 96% success rate with no complications.7PubMed. Milch versus Stimson technique for nonsedated reduction of anterior shoulder dislocation: a prospective randomized trial and analysis of factors affecting success That is a dramatic improvement over the 28% first-attempt rate seen in the trial that used only oral painkillers and basic hanging weights, which underscores how much the details of execution matter.
The “modified Stimson” label gets used loosely in the literature, and it can refer to different things depending on the author. Sometimes it means adding scapular manipulation while traction is applied. Sometimes it means using a specific traction device rather than free-hanging weights. Sometimes it means adjusting the degree of arm abduction or rotation while the patient is prone. All of these modifications share the same goal: overcoming the muscle spasm that is the main barrier to the classic technique’s success. If you hear a clinician refer to the “modified Stimson,” it is worth asking which specific modification they mean, because the differences in execution can meaningfully affect outcomes.
The Prone Position Problem
Lying face down on a table sounds simple enough, but it introduces a set of concerns that do not apply to techniques performed with the patient sitting or lying on their back. For the clinician, monitoring the patient’s airway and breathing is harder in the prone position. This matters most when sedation is involved. If a patient is sedated and lying face down, managing any airway compromise becomes more complicated and potentially dangerous.
A simulation study on emergency airway management in the prone position found that establishing a secure airway while a patient is face down is feasible but significantly more challenging than in the standard supine position, with certain devices performing better than others for temporary airway rescue.8PubMed Central. Emergency airway management in the prone position: an observational mannequin-based simulation study The practical takeaway is that if you are using the Stimson technique with intravenous sedation, the prone position adds a layer of risk that must be actively managed. This is one reason the intra-articular lidocaine approach is a natural partner for this technique: it avoids sedation entirely, sidestepping the airway concern.
There are also patients for whom the prone position itself is problematic. Obese patients may find it difficult to breathe comfortably while lying face down. Patients with rib fractures, chest injuries, or significant abdominal pain may not tolerate it. Pregnant patients in later trimesters cannot safely lie prone. Elderly patients with limited mobility may struggle to get into and maintain the position. For all of these groups, a seated or supine technique is usually a better choice from the start.
Use in Remote and Wilderness Settings
Shoulder dislocations happen outside of hospitals with surprising regularity. Skiing, rock climbing, mountain biking, kayaking, and even hiking with a heavy pack can all result in an anterior shoulder dislocation. In these situations, you may be hours from the nearest emergency department, and the question of which reduction technique to attempt in the field becomes very real.
The Stimson technique’s appeal in wilderness settings is intuitive: it requires no special equipment, no electricity, no sedation drugs. A flat rock, a fallen log, or a camp table can serve as the elevated surface. A water bottle or a stuff sack filled with rocks can serve as the weight. The patient lies face down, the weight hangs, and you wait. For someone with basic training, it feels like the safest option because it avoids the forceful manipulation that could cause a fracture if done incorrectly.
That said, a prospective multicenter observational study of shoulder reduction in remote environments reported a 100% success rate using their method across 39 patients, with a mean pain score of only 1.7 out of 10 and no complications.9PubMed. Reduction of Acute Shoulder Dislocations in a Remote Environment: A Prospective Multicenter Observational Study That study used a specific reduction protocol rather than the classic Stimson method, and the results suggest that for wilderness medicine practitioners, training in a reliable, low-pain technique is more important than defaulting to the Stimson approach simply because it seems gentle. The low pain scores in that study are particularly striking because the patients had no access to any form of sedation or even injectable analgesia.
Still, the Stimson technique remains widely taught in wilderness medicine courses as a first-line or backup option. Its main advantages in the field are that it is hard to do wrong (you are essentially waiting for gravity to work) and it carries little risk of iatrogenic injury. Its main disadvantage is the same one it has in the hospital: if the patient cannot relax their muscles, the technique may simply not work, and in a remote setting you do not have intra-articular lidocaine or sedation as a fallback.
How It Compares to Other Common Techniques
Emergency physicians have a toolkit of shoulder reduction methods, and each has trade-offs in speed, success rate, pain, and the level of sedation required. The Stimson technique sits at the gentle, low-force end of the spectrum but trades that gentleness for reliability.
The Milch technique, as noted earlier, significantly outperformed the Stimson method in a head-to-head trial without sedation.10PubMed. Milch versus Stimson technique for nonsedated reduction of anterior shoulder dislocation: a prospective randomized trial and analysis of factors affecting success The Milch approach involves slowly abducting the arm overhead and externally rotating it, which can be done with the patient lying on their back. It is faster and does not require the prone position, which makes it more practical in many clinical settings.
The external rotation method (sometimes called the Hennepin technique) is another low-force option that can be performed with the patient seated or supine. It involves slowly rotating the forearm outward while the elbow stays at the patient’s side. Like the Stimson approach, it depends on patience and gradual muscle relaxation, but it avoids the prone positioning issue entirely.
The Kocher and Hippocratic methods are older, more forceful approaches that have largely fallen out of favor for routine use because of a higher risk of complications like fractures or nerve damage. The Chair method, which involves having the patient straddle a chair with the affected arm draped over the back while traction is applied, produced notably low pain scores in one comparative study, averaging a visual analog scale score of 4.0 compared to scores above 6.0 for the other techniques tested.11Journal of Orthopaedic Surgery and Research. Comparison of four different reduction methods for anterior dislocation of the shoulder
No single technique is universally best. The choice depends on the clinical scenario: whether sedation is available, the patient’s body type, the type of dislocation, operator familiarity, and practical constraints like whether the patient can lie prone. Many experienced emergency physicians have a preferred method they have used hundreds of times and will default to that. The real skill is in knowing two or three methods well enough to switch if the first attempt fails.
The Stimson Technique for Hip Dislocations
The name “Stimson technique” also appears in orthopedic literature on hip dislocation reduction, which can cause confusion. For hip dislocations, the Stimson maneuver involves the patient lying face down with the affected leg hanging off the end of the table, knee bent to 90 degrees. The clinician applies downward pressure on the lower leg to lever the femoral head back into the hip socket. The gravitational principle is similar to the shoulder version, but the mechanics, forces involved, and clinical context are quite different.
Hip dislocations are far more serious injuries that almost always result from high-energy trauma like car crashes. They typically require procedural sedation or general anesthesia for reduction. A review of hip reduction maneuvers noted that physician safety during the procedure is an underappreciated concern, since many traditional hip reduction techniques require the clinician to lift or brace against the patient’s leg in ergonomically risky positions.12PubMed Central. A Detailed Review of Hip Reduction Maneuvers: A Focus on Physician Safety and Introduction of the Waddell Technique The prone Stimson approach for hips has the advantage of using gravity to assist, but positioning an acutely injured trauma patient face down can be logistically difficult and is not always safe, particularly if there are associated injuries.
When the Stimson Technique Is the Right Call
Despite its mixed results in controlled trials, the Stimson technique still has a place. Its best use case is a patient who is relatively calm, has received adequate local analgesia (ideally intra-articular lidocaine), can comfortably lie prone, and has a straightforward anterior dislocation without associated fractures. In that scenario, the technique is low-risk, requires minimal force, and avoids the need for sedation. It is also well suited to training environments, where its low-force nature means that an inexperienced provider is unlikely to cause harm even if the reduction attempt fails.
Where it tends to fail is with highly anxious patients, those with significant muscle spasm that oral painkillers cannot overcome, patients with recurrent dislocations who may have developed scarring or altered anatomy around the joint, and situations where time is limited. If a Stimson attempt does not work within 15 to 20 minutes, most clinicians will abandon it in favor of a more active technique rather than continuing to wait. As a backup method in a physician’s repertoire or as a first attempt in a low-resource setting, the Stimson technique remains useful. As a primary method for busy emergency departments, the evidence suggests that faster, more reliable options exist.
The broader lesson from the research on shoulder reduction is that technique matters less than execution. Adequate pain control, a calm patient, gentle and patient manipulation, and operator experience consistently predict success across methods. The Stimson technique embodies the gentleness principle better than almost any other approach. Its challenge is that gentleness alone, without the supporting conditions of adequate analgesia and patient relaxation, is often not enough.