Try an interscalene block! It anesthetizes C5-7 and is used in shoulder surgery- surely that is good enough for a measly little reduction. Studies in the ED have shown decreased time in the ED and good anesthesia for shoulder reduction.

Here is how:

  1. Place patient in supine position
  2. Using the linear ultrasound probe oriented like this:
  3. Identify the subclavian artery
  4. The brachial plexus looks like a “bundle of grapes” lateral the the subclavian artery
  5. Trace the brachial plexus superior with the transducer horizonal
  6. At the C6 level you can see the nerve roots within the interscalene groove with transducer in a vertical position
  7. Insert needle and inject anesthetic (12-30mL)
  8. You should see anesthetic spread surrounding the nerve roots

Complications to know about

  • phrenic nerve block – causing hemi diaphragmatic paralysis
  • horners syndrome
  • pneumothorax

Want to watch a video?

Want to read more?

Blaivas M. et al. Ultrasound-guided interscalene block for shoulder dislocation reduction in the ED. Am J Emerg Med. 2006;24(3):293.

Blaivas M. et al. A prospective comparison of procedural sedation and ultrasound-guided interscalene nerve block for shoulder reduction in the emergency department. Acad Emerg Med. 2011;18(9):922. Epub 2011 Aug 30.

Raeyat D et al. Ultrasound-guided interscalene nerve block vs procedural sedation by propofol and fentanyl for anterior shoulder dislocations. Am J Emerg Med. 2017;35(10):1435. Epub 2017 Apr 14.