A while back I learned about the FARES method for reduction of anterior shoulder dislocations from the guys from Vanderbilt. Missing out the ‘do one‘ step of the classic trifecta of medical learning, I encouraged a colleague to use the FARES technique to reduce a child’s dislocated shoulder.
The reduction went so well that that the child’s mother asked if we would write down how to perform the procedure in the patient’s notes in case of a re-dislocation…
The FARES method is similar to the Milch technique
- While holding the patient’s wrist, apply traction to the affected limb in a neutral position beside the supine patient (can also be performed in the prone position).
- Move the limb anteriorly and posteriorly in small oscillating movements while continuing to apply traction and start slowly abducting the limb.
- Once the limb is abducted to 90 degrees, externally rotate the limb at the shoulder, with ongoing traction and oscillating anterior/ posterior movements. Continue to slowly abduct the limb past this position.
- Clunk! Reduction is usually achieved once the limb is abducted to 120 degrees.
I’m not a zealot of any particular shoulder reduction reduction technique (I like them all… it would be boring to do it the same way every time) but based on this n=1 trial, the FARES method is a string well worth adding to your bow. We performed the procedure with nitrous oxide and ‘Sponge Bob Square Pants’ on TV.
- 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 Dec;91(12):2775-82. PMID: 19952238.