A comparative study of the Milch method and the Spaso method in the reduction of anterior dislocation of the shoulder


  • Chaitanya P. R. Department of Orthopaedics, Shimoga Institute of Medical Sciences, Shivamogga, Karnataka, India
  • Naveen P. R. Department of Orthopaedics, Shimoga Institute of Medical Sciences, Shivamogga, Karnataka, India
  • Kiran Kumar H. G. Department of Orthopaedics, Shimoga Institute of Medical Sciences, Shivamogga, Karnataka, India




Milch, Spaso, Anterior dislocation shoulder, Glenohumeral dislocation


Background: The Milch and Spaso methods are used for reduction of anterior shoulder dislocation of the shoulder. This study was undertaken to compare the efficacy of these two methods.

Methods: Sixty patients with anterior glenohumeral dislocation were included in this study. 30 patients were reduced by each of the 2 methods and the efficacy and the pain experienced by the patient was studied.

Results: Both methods were found to be equally efficacious. The pain felt by the patient was lower in the Milch method but this was not statistically significant.

Conclusions: Both the Milch and the Spaso methods are equally effective methods for reduction of anterior dislocation of the shoulder.

Author Biography

Chaitanya P. R., Department of Orthopaedics, Shimoga Institute of Medical Sciences, Shivamogga, Karnataka, India

Associate Professor,

Department of orthopaedics,

Shimoga institute of medical sciences,



Hovelius L. Incidence of shoulder dislocation in Sweden. Clin Orthop Relat Res. 1982;166:127–31.

Westin CD, Gill EA, Noyes ME, Hubbard M. Anterior shoulder dislocation. A simple and rapid method for reduction. Am J Sports Med. 1995;23(3):369-71.

Kwon YW, Kulwicki KJ, Zuckerman JD. Glenohumeral Joint Subluxations, Dislocations, and stability. In: Bucholz RW, Heckman JD, Court-brown CM, Tornetta P. Rockwood and Green’s fractures in adults. 7th edition. Philedelphia: Lippincott Williams & Wilkins; 2010: 1285-1330.

Browner BD, Jupiter JB, Levine AM, Trafton PG. In: Skeletal trauma. 2nd ed. Philadelphia: WB Saunders Co; 1998.

Visser CP, Coene LN, Brand R, Tavy DL. The Incidence of nerve injury in anterior dislocation of the shoulder and its influence on functional recovery. A prospective clinical and EMG study. J Bone Joint Surg Br. 1999;81(4):679–85.

Yeap JS, Lee DJ, Fazir M, Kareem BA, Yeap JK. Nerve injuries in anterior shoulder dislocations. Med J Malaysia. 2004;59:450–4.

Robinson CM, Shur N, Sharpe T, Murray IR. Injuries associated with traumatic anterior glenohumeral dislocations. J Bone Joint Surg Am. 2012;94:18–26.

Kralinger FS, Golser K, Wischatta R, Wambacher M, Gernot S. Predicting recurrence after primary anterior shoulder dislocation. Am J Sports Med. 2002;30(1):116-20.

Hoelen MA, Burgers AM, Rozing PM. Prognosis of primary anterior shoulder dislocation in young adults. Arch Orthop Trauma Surg. 1990;110(1):51-4.

Vermeiran J, Handelberg F, Casteleyn PP, Opdecam P. The rate of recurrence of traumatic anterior dislocation of the shoulder. A study of 154 cases and a review of the literature. Int Orthop. 1993;17(6):337-41.

Cunningham NJ. Technique for reduction of antero inferior dislocation. Emerg Med Australas. 2005;17(5-6):463-71.

Chung CH. Closed reduction technique for acute anterior shoulder dislocation: from Egyptians to Australians. Hong Kong J Emerg Med. 2004;11(3):178-88.

Thakur AJ, Narayan R. Painless reduction of shoulder dislocation by Kocher’s method. J Bone Joint Surg Br. 1990;72:524.

Guler O, Ekinci S, Akyildiz F, Tirmik U, Cakmak S, Ugras A, et al. Comparison of four different reduction methods for anterior dislocation of the shoulder. J Orthopaed Surg Res. 2015;10:80.

Amar E, Maman E, Khashan M, Kauffman E, Rath E, et al. Milch versus Stimson technique for non-sedated reduction of anterior shoulder dislocation: a prospective randomized trial and analysis of factors affecting success. J shoulder Elbow Surg. 2012;21(11):1443-9.

Noordeen MH, Bacarese-Hamilton IH, Belham GJ, Kirwan EO. Anterior dislocation of the shoulder: A simple method for reduction. Injury. 1992;23:479-80.

Mahiroğullari M, Akyildiz F, Kőksal I, Cakmak S, Kűrklű M, kuşkucu M. Chair method: A simple and safe method for reduction of anterior shoulder dislocation. Acta Orthop Traumatol Turc. 2012;46(2):102-6.

Marinelli M, de Palma L. The external rotation method for reduction of acute anterior shoulder dislocations. J Orthop Traumatol. 2009;10(1):17-20.

Ceroni D, Sadri H, Levenberger A. Antero inferior shoulder dislocation: An auto-reduction method without analgesia. J Orthop Trauma. 1997;11(6):399-404.

Bosley RC, Miles JC. Scapula manipulation for reduction of anterior dislocations: A new procedure. AAOS. 1979: 23.

Baykal B, Sener S, Turkan H. Scapular manipulation technique for reduction of traumatic anterior shoulder dislocations: experiences of an academic emergency department. Emerg Med J. 2005;22:336-8.

Sayegh FE, Kenanidis EI, Papavasiliou KA, Potoupnis ME, Kirkos JM, Kapetanos GA. Reduction of acute anterior dislocations: a prospective randomized study comparing a new technique with the Hippocratic and Kocher methods. J Bone Joint Surg Am. 2009;91(12):2775–82.

Doshi D, Firke R. A New Patient-Controlled Technique for Shoulder Relocation in Emergency Departments. Am J Case Rep. 2014;15:485-7.

Miljesic S, Kelly AM. Reduction of anterior dislocation of shoulder by Spaso technique. Emerg Medicine. 1998;10:173-5.

Yuen MC, Tung WK. Reducing anterior shoulder dislocation by the Spaso technique. Hong Kong J Emerg Med. 2001;8(2):96-100.

Milch H. The treatment of recent dislocations and fracture dislocations of the shoulder. J Bone Joint Surg Am.1949;31(1):173–80.

Johnson G, Hulse W, McGowan A. The Milch technique for reduction of anterior shoulder in an accident and emergency department. Arch Emerg Med. 1992;9(1):40-3.

Rezende BRM, Almeida Neto JI, Sousa UJ, Bomfim LS, Ferreira Júnior MS. Glenoumeral dislocation: a prospective randomized study comparing Spazo and Kocher maneuvers. Acta Ortop Bras. 2015;23(4):192-6.

Harnroongroj T, Keeratipongpaiboon K, Lertudomphonwanit T, Harnroongroj T. Sedative-free Reduction of Acute Anterior Shoulder Dislocation Saves Post reduction Service time in the Emergency Room. Thai J Surg. 2001;32(2):49-52.

Daya M. Shoulder. In: Marx JA, Hockberger RS, Walls RM, editors. Rosen’s emergency medicine. Concepts and clinical practice. 5th ed. Missouri: Mosby Inc; 2002: 576–606.

Pimpalnerkar A, Datta A, Longhino D, Mohtadi N. An unusual complication of Kocher’s manoeuvre. BMJ. 2004;329:1472–3.

Chaitanya PR, Chethan PR, Naveen PR, Sunil M P, Azeem A. Modified Milch Technique: A Safe and Painless Method for Reduction of Anterior Shoulder Dislocation. Int J Med Res Rev. 2014;2(5):439- 43.






Original Research Articles