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The protocol outlines purpose, scope, eligibility criteria for adult emergency department patients, and specific contraindications including fractures, duration >7 days, polytrauma, intoxication, pregnancy, frailty, and severe cardiopulmonary disease. It details location, safety and monitoring requirements, equipment including opioid analgesia options, stepwise preparation, prone positioning with wrist hook traction, timing and reassessment, additional manoeuvres, post-reduction neurovascular checks, imaging confirmation, sling care, discharge planning, and common pitfalls.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/anterior-shoulder-reduction-stimson-hanging-arm-technique-standard-operating-procedure/640671/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/anterior-shoulder-reduction-stimson-hanging-arm-technique-standard-operating-procedure/640671.png","ImageObject",300,407,{"name":92,"@type":93},"fresh2021","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-13","2026-10-22",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Who is eligible to receive the Stimson hanging arm reduction in the emergency department?","Question",{"text":113,"@type":114},"Adult patients (>16 years) with isolated anterior shoulder dislocation that is confirmed on X-ray, who can tolerate prone positioning for at least 30 minutes, are independently mobile, and are medically fit.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What are the key contraindications to the technique?",{"text":118,"@type":114},"Contraindications include associated fractures that preclude closed reduction, dislocations older than 7 days, polytrauma, clinical intoxication or inability to cooperate, pregnancy (due to prone discomfort/aortocaval compression), frailty, severe cardiopulmonary disease, and any comorbidity making prone positioning unsafe or difficult.",{"name":120,"@type":111,"acceptedAnswer":121},"How is success assessed and what happens if reduction is not achieved within the time limit?",{"text":122,"@type":114},"Reduction is reassessed at 10 minutes and the attempt continues up to a total of 25 minutes. If there is no reduction after 20 minutes, additional manoeuvres are used; if still unreduced by 25 minutes, stop the attempt and consider formal procedural sedation or orthopaedic referral, with post-reduction neurovascular checks and X-ray confirmation.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},640671,1792768679,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},962093912154,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Standard Operating Procedure  \nAnterior Shoulder Reduction-Stimson (Hanging Arm) Technique  \n1. Purpose  \nProvide a safe, reproducible method for reducing anterior shoulder dislocations using gravity assistance while minimising patient discomfort and the need for procedural sedation.  \n2. Scope  \n􀁸 Adult patients (>16 yr) with isolated anterior shoulder dislocation presenting to the Emergency Department.  \n􀁸 Excludes complex fracture-dislocations and polytrauma.  \n3. Indications  \n• Confirmed anterior shoulder dislocation on X-ray.  \n• Patient can lie prone for ≥ 30 minutes, is independently mobile and medically fit.  \n• Useful whilst awaiting procedural sedation or as a first-line technique.  \n4. Contraindications  \n• Associated fractures that would otherwise preclude closed reduction e.g. surgical neck of humerus; glenoid rim.  \n• Dislocations >7 days old.  \n• Polytrauma  \n• Clinical intoxication or inability to cooperate.  \n• Pregnancy (prone position discomfort/ aortacaval compression)  \n• Frailty  \n• Severe cardiopulmonary disease.  \n• Any other comorbidities that would make prone positioning challenging or unsafe.  \n5. Location & Safety  \n• Perform in Pod A or B (RIE ED) or equivalent cubicle with immediate staff visibility.  \n• In terms of observations, if IV opioid used then patients require pulse oximetry at minimum to ensure monitoring of oxygen saturations and heart rate.  \n• Provide lone patients with a remote call bell for the unaffected hand.  \n6. Equipment Checklist  \n\n| Item | Check |\n| --- | --- |\n| Bed with height adjustment |  |\n| Pillow for head support |  |\n| Wrist hook strap (stored in Anaesthetic Room cupboard) |  |\n| Kettlebells: 2kg; 4kg; 6kg; 8kg (stored in Anaesthetic Room cupboard) |  |\n| Stockinette & Soft Band (labeled as 7.5 cm ortho padding in Plaster Trolley) |  |\n| Analgesia:\u003Cbr>- IV access + Fentanyl (25-50 mcg IV) or Morphine (2 .5-5mg IV) OR\u003Cbr>- Consider administering Oramorph 5-10mg if identified early ([e.g. at](e.g. at) triage while awaiting a cubicle or equipment), bearing in mind that it takes 1-2 hrsto reach peak effect |  |\n| Post-reduction sling |  |\n| Optional -Entonox (50% nitrous oxide; 50% oxygen) |  |\n\n8. Procedure  \n8.1 Preperation & Consent  \n1. Review pre-reduction X-ray, confirm dislocation and exclude fracture.  \n2. Explain procedure , anticipated duration (up to 25 minutes) and success rate (~80%) .  \n3. Obtain verbal or written consent.  \n4. Offer and administer opioid analgesia (unless contraindication) +/-Entonox  \n8.2 Positioning:  \n▫ The patient should lie prone on the bed with their head resting on a pillow. The bedside should be up, and the injured arm should be hanging over the side (see Figure 1) .  \n▫ Avoid any metal protrusions from the trolley edge. The patient may need to move down the bed slightly to do so (see Figure 2) .  \n▫ Ensure the bed height allows the arm to hang freely with no obstruction.  \n▫ Ask the patient to turn their head away from the injured side.  \n▫ Secure a wrist hook strap on the patient’s forearm (the hook should sit in the palm of the patient’s hand) .  \nFigure 1: Correct positioning  \nFigure 2: Avoid metal protrusions from the trolley edge such as the one shown here (red circle) .  \n8.3 Reduction  \n\n| Time | Action |\n| --- | --- |\n| 0 min | Attach 2-4kg kettlebell-choose lighter weight for low muscle tone, heaver for muscular build. Ensure free hanging |\n| 10 min | Re-assess: if no reduction, increase weight to 6-8kg. Encourage deep breathing/ relaxation. |\n| 20 min | If still unreduced, proceed to *Additional manoeuvres* |\n| 25 min | Stop current attempt and consider formal procedural sedation or Orthopaedic referral. |\n\nMost patients describe a sudden‘clunk’ or pain relief on reduction. Visually confirm restored contour.  \n8.4 Additional Manoeuvres  \n1. Gentle external rotation of forearm by assistant while weight hangs  \n2. Scapular manipulation technique:  \nUse the fingers of one hand to stabilise the superior aspect (base) of th","cbCailfgnpWcYDyL","https://ap.wps.com/l/cbCailfgnpWcYDyL","pdf",391226,"English","# Purpose\n# Scope\n# Indications\n# Contraindications\n# Location & Safety\n# Equipment Checklist\n# Procedure\n## Preparation & Consent\n## Positioning\n## Reduction\n## Additional Manoeuvres\n## Post-reduction Care\n# Warnings & Common Pitfalls\n# References","[{\"question\":\"Who is eligible to receive the Stimson hanging arm reduction in the emergency department?\",\"answer\":\"Adult patients (\\u003e16 years) with isolated anterior shoulder dislocation that is confirmed on X-ray, who can tolerate prone positioning for at least 30 minutes, are independently mobile, and are medically fit.\"},{\"question\":\"What are the key contraindications to the technique?\",\"answer\":\"Contraindications include associated fractures that preclude closed reduction, dislocations older than 7 days, polytrauma, clinical intoxication or inability to cooperate, pregnancy (due to prone discomfort/aortocaval compression), frailty, severe cardiopulmonary disease, and any comorbidity making prone positioning unsafe or difficult.\"},{\"question\":\"How is success assessed and what happens if reduction is not achieved within the time limit?\",\"answer\":\"Reduction is reassessed at 10 minutes and the attempt continues up to a total of 25 minutes. If there is no reduction after 20 minutes, additional manoeuvres are used; if still unreduced by 25 minutes, stop the attempt and consider formal procedural sedation or orthopaedic referral, with post-reduction neurovascular checks and X-ray confirmation.\"}]","Anterior Shoulder Reduction - Stimson (Hanging Arm) Technique - Standard Operating Procedure | PDF",1792710231,13]