FARES Method May Reduce Anterior Shoulder Dislocation with Less Pain

By Stephanie Lachapelle for Shoulder1.com In a study recently published in the Journal of Bone and Joint Surgery, Greek orthopedic surgeons describe the FARES method of anterior should dislocation reduction that causes less pain than the current two methods of reduction. FARES stands for fast, reliable and safe, and is used to replace the head of the humerus back in the shoulder socket when it has popped out in a forward direction. This injury is common in falls onto the extended arms or hands, in sports activities and in car accidents. Two other methods, the Hippocratic method and the Kocher method, are presently the most commonly used procedures to reduce anterior shoulder dislocation. In the Hippocratic method, the patient is placed on his back and the physician applies downward force to the straight injured arm while rotating the arm, in 60 second intervals until the humerus moves back into the socket. In the Kocher method, the arm is bent to 90 degrees and adducts the forearm (moves the arm toward the body), while the arm is rotated outward until the palm faces up. Then the arm is lifted up while the physician rotates the arm until it pops back into the socket. In many cases these methods successfully reduce the dislocation, but some difficult cases require several attempts. Each non-surgical attempt to relocate the shoulder causes pain. During this study, researchers found that the FARES method caused less pain and was equally as successful at reducing the dislocation as the Hippocrates and Kocher methods. Reduction using the FARES method is accomplished with the patient on his back, and begins with the injured arm in a neutral, midline position. Gentle traction is placed on the hand to bring the arm away from the head. The arm is moved away from the body toward the feet as the physician applies a vertical oscillating movement. This is continued until the arm slips back into the shoulder socket. The study tested whether the first reduction was successful, the duration of the procedure and the pain experienced by the patient for each method. Subjects were randomly assigned to a method. 88.7% of FARES method attempts were successful, compared to 72.5% for the Hippocrates method and only 68% for the Kocher method. Patients in the FARES group reported much less pain than those in the other two groups, as measures by the visual analog scale of pain measurement, and the FARES method lasted a maximum of 3.5 minutes, as compared to the up to 7 minute duration for each other two treatments. The authors conclude that the FARES method of anterior dislocation reduction is a reliable, faster and less painful method of reduction.

Last updated: 27-Jan-10