The Clinical Study Of Manual Reduction Of Anterior Shoulder Dislocation Was Reviewed With Literature Review

Objective:This study aims to investigate the mechanisms of reduction techniques,specifically the outward external rotation method and hand holding and foot stepping method,for shoulder joint dislocation through literature review and clinical observations.The goal is to provide recommendations for selecting the optimal reduction method for different patients,thus offering reference guidelines for optimizing traditional Chinese medicine treatment of shoulder joint dislocation.Methods:1.Literature Research: A comprehensive search was conducted using free text and subject terms.The search included "shoulder joint anterior dislocation" and "manual therapy." Chinese databases,including CNKI,Wanfang Data,and VIP Database,were searched for relevant literature published from the establishment of the databases up to December 31,2022.To ensure inclusiveness,manual and gray literature searches were conducted.Relevant references were traced and included when necessary.Statistics of all maneuvers mentioned in the literature and ranking their frequencies to summarize the included literature of randomized controlled studies.2.Clinical Research: Sixty patients diagnosed with shoulder joint anterior dislocation who visited the Department of Orthopedics in Yunnan Provincial Hospital of Traditional Chinese Medicine from October 2021 to October 2022 were included.Patients were randomly divided into a treatment group(n=30)and a control group(n=30).The treatment group underwent outward external rotation method reduction,while the control group underwent hand holding and foot stepping method reduction.The differences in Visual Analog Scale(VAS)scores,shoulder joint functional scores,University of California,Los Angeles(UCLA)shoulder joint functional scores,reduction success rate,reduction time,complications after reduction,and recurrence rate were compared between the two groups before and after reduction.Results:1.Literature Research: A total of 309 articles on manual therapy for shoulder joint anterior dislocation were included in this literature review since the establishment of the database.These articles covered 56 different reduction methods,with the top 20 commonly used methods being outward external rotation method,hand holding and foot stepping method,chair-back reduction method,zero-degree reduction method,traction-adduction-internal rotation method,lateral decubitus position method,modified Milch method,and antagonistic traction method.The majority of studies included were non-randomized controlled trials(approximately95%),while the number of randomized controlled trials(RCTs)focusing on reduction techniques was limited.2.Clinical Research: In the treatment group,29 cases achieved successful reduction,while 1 case failed and required successful reduction under anesthesia.In the control group,23 cases achieved successful reduction,while 7 cases failed.Among the 7 cases in the control group,5 cases were subsequently successfully reduced using the outward external rotation method,and 2 cases were successfully reduced under anesthesia.The success rates of reduction were 96.7% in the treatment group and 76.7% in the control group,with a statistically significant difference(χ~2=10.026,p=0.018).The mean reduction time was 7.27±1.98 minutes in the treatment group and 17.50±2.97 minutes in the control group,with a significantly shorter time in the treatment group(t=15.705,p<0.001).The VAS scores after reduction were significantly lower in the treatment group(median: 2.00,interquartile range: 1.00-2.25)compared to the control group(median: 4.00,interquartile range:3.00-4.00)(Z=-6.047,p<0.001).The shoulder joint functional scores after reduction were higher in the treatment group(median: 95.50,interquartile range: 92.00-98.25)than in the control group(median: 81.5,interquartile range: 78.00-87.00)(Z=-6.447,p<0.001).The recurrence rate was lower in the treatment group(2 cases)than in the control group(8 cases),with a statistically significant difference(t=2.121,p<0.001).The efficacy evaluation using the UCLA shoulder joint functional scores after reduction in the treatment group showed 17 cases as excellent,11 cases as good,and2 cases as poor,while in the control group,12 cases were excellent,8 cases were good,and 10 cases were poor.The difference between the treatment and control groups was statistically significant(χ~2=7.990,p=0.018).One month later,the UCLA shoulder joint functional scores in the treatment group showed 20 cases as excellent,5cases as good,and 1 case as poor with 4 cases of recurrence.In the control group,13 cases were excellent,3 cases were good,and 9 cases were poor with 5 cases of recurrence.The difference between the treatment and control groups was statistically significant(χ~2=8.496,p=0.037).Conclusions:1.Literature Research Conclusion: The results of the literature research revealed that the most commonly used reduction methods for shoulder joint dislocation in clinical practice are the outward external rotation method and the hand holding and foot stepping method,with similar frequencies.The majority of included studies focused on non-randomized controlled trials,accounting for approximately 95%.And approximately 5% of the studies of manipulative repositioning RCTs were designed according to the principle of randomization.Fewer studies utilized randomized controlled trial designs for reduction techniques,and the quality of the literature varied.Complications,shoulder joint function evaluation,and follow-up assessments were inadequately addressed.There are some shortcomings in the study design approach for the literature.Specific which method has better efficacy,medical experts and scholars have varied opinions,there is no unified view,which also provides reference ideas for the clinical observation part of this paper,so the next clinical observation will focus on these two methods to study,and strive to choose the optimal reset method.2.Clinical Research Conclusion: Compared to the hand holding and foot stepping method,the outward external rotation method demonstrated advantages in terms of reduced patient discomfort during reduction,better post-reduction functional outcomes,higher success rates,shorter duration,fewer complications,and lower recurrence rates.The outward external rotation method is considered a more suitable reduction technique for shoulder joint dislocation.3.Relevance between Literature Research and Clinical Research: The literature research results served as the basis for the clinical research,which focused on comparing the advantages and disadvantages of the outward external rotation method and the hand holding and foot stepping method through the collection and analysis of clinical cases.Ultimately,the outward external rotation method was identified as the more suitable clinical treatment for shoulder joint dislocation reduction.These findings provide a reference basis for optimizing traditional Chinese medicine treatment methods for shoulder joint dislocation reduction.