The Noergaard Technique for Anterior Shoulder Dislocation

The Noergaard Technique, a Simple and Non-traumatic Method for Reduction of Anterior Shoulder Dislocations

In this paper we describe and evaluate the results of the Noergaard technique through a retrospective analysis of patients admitted and treated for anterior shoulder dislocation at the ED of Copenhagen University Hospital Hvidovre, Denmark, in a 1-year period.

Study Overview

• Status: Completed
• Conditions: Anterior Shoulder Dislocation
• Intervention / Treatment: Procedure: Noergaard technique

Detailed Description

Introduction

In this article the investigators describe the Noergaard technique for reduction of anterior shoulder dislocations. This is an atraumatic reduction method that has proven successful through several years of practice. The investigators describe and evaluate the results of this technique through a retrospective analysis of patients admitted and treated for anterior shoulder dislocation at the emergency department (ED) of Copenhagen University Hospital Hvidovre, Denmark, in a 1-year period.

Methods

In the Noergaard technique the patient is placed standing bend over forwards in front of the rail on a hospital bed, resting the forehead on the back of the non-affected forearm, which is put on the rail. The affected arm should now be relaxed and stretched, hanging straight down toward the floor. The patient is then instructed to attempt to relax and make pendular and circular motions with the affected arm hanging down.

• Study Type: Observational
• Enrollment (Actual): 151

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 14 years to 85 years (ADULT, OLDER_ADULT, CHILD)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

The study population is chosen from the criteria that patients have had a closed shoulder reduction performed at the emergency center of Hospital of Hvidovre between 1st of January 2014 and the 31st of December 2014.

Description

Inclusion Criteria:

- Patients have had a closed shoulder reduction performed at the emergency center of Hospital of Hvidovre between 1st of January 2014 and the 31st of December 2014.

Exclusion Criteria:

• Patients with diagnosed severe arthrosis in the shoulder joint.
• Patients with malignancy in the humerus or scapula.
• Patients who have had a Total Shoulder Arthroplasty performed at the same side as the lunation.
• Patients with more than four previous shoulder reductions performed.
• Patients who have undergone operations on the same shoulder, but at different hospitals.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Intervention / Treatment

ED Patients; We retrospectively reviewed patient charts of all patients admitted for shoulder dislocation at the ED at Copenhagen University Hospital Hvidovre between January 1st 2014 and December 31st 2014. A total of 151 patients' charts were reviewed.

Procedure: Noergaard technique; The patient is placed standing in an upright position in front of the rail on a hospital bed. Legs should be stretched with a wide well balanced stance. The patient is then instructed to bend forwards, resting the forehead on the back of the non-affected forearm, which is put on the rail. The affected arm should now be relaxed and stretched, hanging straight down toward the floor. The patient is then instructed to attempt to relax and make pendular and circular motions with the affected arm hanging down. Successful reduction occurs when sufficient muscle relaxation allows the humeral head to reposition to its natural position in the glenoid fossa. Often the patient will experience a popping sensation when the shoulder is reduced.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Successful shoulder reduction after anterior shoulder dislocation.	Successful shoulder reduction occurs when sufficient muscle relaxation allows the humeral head to reposition to its natural position in the glenoid fossa.	30 min.

Collaborators and Investigators

• Sponsor: Copenhagen University Hospital, Hvidovre
• Investigators: Study Director: Nikolaj Erin-Madsen, MD, Copenhagen University Hospital of Hvidovre

Publications and helpful links

General Publications

• Canale ST, Beaty JH, Phillips BB. Recurrent dislocation in Canley and Beaty: Campbell's Operative Orthopaedics. 11th edition. Vol. 45. Philadelphia: Mosby Elsevier; 2007. pp. 2677-83.
• Beattie TF, Steedman DJ, McGowan A, Robertson CE. A comparison of the Milch and Kocher techniques for acute anterior dislocation of the shoulder. Injury. 1986 Sep;17(5):349-52. doi: 10.1016/0020-1383(86)90161-0.
• Manes HR. A new method of shoulder reduction in the elderly. Clin Orthop Relat Res. 1980 Mar-Apr;(147):200-2.
• Plummer D, Clinton J. The external rotation method for reduction of acute anterior shoulder dislocation. Emerg Med Clin North Am. 1989 Feb;7(1):165-75.
• Marinelli M, de Palma L. The external rotation method for reduction of acute anterior shoulder dislocations. J Orthop Traumatol. 2009 Mar;10(1):17-20. doi: 10.1007/s10195-008-0040-4. Epub 2009 Jan 8.
• MILCH H. The treatment of recent dislocations and fracture-dislocations of the shoulder. J Bone Joint Surg Am. 1949 Jan;31A(1):173-80. No abstract available.
• Canales Cortes V, Garcia-Dihinx Checa L, Rodriguez Vela J. Reduction of acute anterior dislocations of the shoulder without anaesthesia in the position of maximum muscular relaxation. Int Orthop. 1989;13(4):259-62. doi: 10.1007/BF00268508.
• Erin-Madsen N, Ban I, Thomsen MG, Noergaard J, Tengberg PT. The Noergaard technique is a non-traumatic method for reduction of anterior shoulder dislocation. Dan Med J. 2021 Mar 17;68(4):A06200422.

Study record dates

Study Major Dates

• Study Start (ACTUAL): January 1, 2014
• Primary Completion (ACTUAL): December 31, 2014
• Study Completion (ACTUAL): December 15, 2016

Study Registration Dates

• First Submitted: August 23, 2018
• First Submitted That Met QC Criteria: August 25, 2018
• First Posted (ACTUAL): August 28, 2018

Study Record Updates

• Last Update Posted (ACTUAL): August 28, 2018
• Last Update Submitted That Met QC Criteria: August 25, 2018
• Last Verified: August 1, 2018

More Information

Terms related to this study

• Keywords: Shoulder; Dislocation; Reduction; Noergaard
• Additional Relevant MeSH Terms: Wounds and Injuries; Joint Diseases; Musculoskeletal Diseases; Shoulder Injuries; Joint Dislocations; Shoulder Dislocation
• Other Study ID Numbers: Noergaard Study

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: There is no IPD sharing plan.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No