A while back I learned about the FARES method for reduction of anterior shoulder dislocations from the guys at Keeping Up with Emergency Medicine. Missing out the ‘do one’ step of the classic trifecta of medical learning, I encouraged a colleague to use the 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 redislocation…
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.