The Cunningham Technique

Young male with history of psychiatric illness and seizures presents with left arm pain after a fall. Patient thinks he slipped on ice, but is unsure. He reports no LOC, no head pain, no neck pain. Does not believe he had a seizure. No urinary incontinence, no tongue biting. Has severe pain in left shoulder. Physical exam shows small forehead abrasion, no c-spine tenderness, and decreased ROM to left shoulder.  He holds his arm internally rotated and adducted. There is an obvious deformity to the left shoulder with a defected palpated anterior.

3 view x rays ordered in triage read as negative for fracture or dislocation, but limited by poor patient positioning.

1

2

3

I was pretty sure that it was dislocated, so I went ahead and ordered the definitive axillary view.

As I was charting on another patient, the x-ray tech came over, looking slightly embarrassed, and said that she was pretty sure she had just reduced my patient’s shoulder as she was trying to get him in the proper position for the axillary view.  She said, “It was amazing, he couldn’t move it, then pop, and he has full ROM now.”

Nice.

Two minutes later, got a phone call from radiology…Might have missed a posterior dislocation…Looks great in the axillary view now…Would recommend getting repeat normal films to be sure that there was no fracture missed while it was not in proper position.

4

Ordered the repeat 3 view x-rays and went to make sure he was still reduced.  Found my patient still internally rotated, in pain, not able to move, and still with the hollow anteriorly.  Gently held his hand and arm and before he realized what I had done, pulled slightly and externally rotated and put it back in place.  As I called for the sling, he went to take his gown off and it slid back out as he extended his arm and moved it anteriorly.  Tried again to gently externally rotate it, but he was now on to me and and was tense and pulling against me.  Asked for suggestions other than sedation and got one from the one and only Dr. Martin Huecker: Try the Cunningham technique.

I went back in his room. He was looking a little wary.  I told him it’s not going to hurt; I was just going to massage his arm a little bit to see if it will go back in.  I held his left forearm in my left hand at the elbow and, using my right hand, massaged first his trapezius, then his deltoid, then his biceps, then his deltoid, then his trapezius, then his deltoid ….annnnnnnnnnnnd….. it slid back in place.  Patient looked as surprised as I did.  Immediately put him in a sling and swathe.  Got repeat x-rays in the sling.

5

6

7

He was in the department for about 30 minutes after that while awaiting x-ray reads and his arm stayed reduced while in the splint.  No fractures on x-ray.  He was discharged with orthopedic follow up in the sling.

One can find is a formal description of The Cunningham technique from the blog “Life in the Fast Lane.” http://lifeinthefastlane.com/cunninghams-shoulder-relocation/

  • Inform the patient of the procedure and the fact that it will be painless. It is important to relax the patient and confident reassurance is the first step towards this.
  • Sit the patient up with the back vertical. This can be done on a bed, chair or trolley, but preferably seated on a non-wheeled chair without arm rests.
  • Carefully support the arm while it is moved into the correct position, allowing the patient to help with the other arm. The correct position is with the arm adducted (next to the body) and pointing vertically down, the elbow is flexed at 90 degrees so that the forearm points horizontally and anteriorly.
  • The operator then squats/kneels to the side of the patient and facing the opposite direction to the patient. The operator then slips the hand between the patients forearm and body so that the patient’s wrist/hand is resting on the operator’s upper arm. Do not make pulling movements at any time as this will elicit pain and result in spasm.
  • Apply steady, very gentle traction (the weight of the operators forearm is quite enough) directly downwards once the patient is settled and pain free. Keep this gentle weight on the arm throughout, stop if any spasm or pain. Usually resting with the patients arm in this position will start to reduce the pain of spasm.
  • With the other hand, the operator then massages the trapezius, deltoid and biceps muscle sequentially, repeating this process and concentrating on the biceps brachii until the muscles are fully relaxed. A strong kneading of the biceps with the thumb anterior and the four fingers of the operator posterior to the arm is recommended. At this point the humeral head will relocate usually without any clear indication that the shoulder has reduced (no sound or ‘clunk’ feeling). This means that the shoulder must be observed/checked regularly to confirm when relocation has occurred (with shoulder exposed movement can be seen as the ‘step’ disappears.)

And a link to the blog with the description. It has a nice video.

7 thoughts on “The Cunningham Technique

  1. How To Get Rid Of Smile Lines The Only Guide You Need

    **We look forward to seeing you.**

    Welcome to your journey toward reclaiming your youthful glow!
    Whether you’re noticing the first traces of smile
    lines or looking for a more refined aesthetic, there’s no better time than now to take
    charge of your beauty. Let’s explore how to smooth out those years and restore your natural radiance.

    **Smoothing Out the Years: How to Get Rid of Smile Lines**

    Those pesky smile lines can be frustrating, but understanding their origin is the first step toward erasing them.
    Smile lines, or perioral rhytides, typically form due to
    a combination of aging, sun exposure, and frequent muscle use like frowning or smiling.
    Over time, collagen and elastin in the skin degrade,
    leading to loss of elasticity and structure, which
    allows these lines to appear.

    **Understanding the Origin of Smile Lines**

    The presence of smile lines is not just about age; environmental factors play a significant role
    too. Prolonged sun exposure can weaken collagen fibers, making the skin less resilient.
    Additionally, repeated facial movements contribute to the formation of these lines,
    as constant muscle activity creates grooves that become
    visible over time.

    **Collagen and Elastin: The Building Blocks of Youthful Skin**

    Collagen and elastin are the cornerstones of youthful
    skin. Collagen provides volume and structure, while elastin ensures flexibility.
    As we age, collagen decreases, leading to sagging, and elastin becomes less elastic,
    causing lines and wrinkles. Understanding this relationship is key to reversing
    signs of aging.

    **A Tailored Approach for Every Skin Type**

    Your journey to smoother skin should be personalized..Skin types vary—some have thicker skin with more fat,
    while others have thinner skin with fewer muscles.
    A tailored approach considers factors like skin thickness, muscle structure, and lifestyle to recommend
    the most effective treatments.

    **Non-Invasive Treatments for Smile Lines**

    For those seeking less downtime, non-invasive treatments are a great starting point.

    Botox works by temporarily relaxing facial muscles, smoothing lines without surgery.
    Dermal fillers add volume back into the skin, plumping out smile lines and enhancing overall structure.

    **Laser Treatments: Resurfacing Beauty**

    Laser resurfacing is another popular choice, using light to heat skin layers and stimulate
    collagen production. This can reduce fine lines and improve texture without significant
    downtime.

    **Embracing Non-Invasive Treatments**

    Non-invasive options are appealing for their ease and quick results.

    They often require minimal recovery time, making them ideal for
    busy lifestyles while still delivering noticeable improvements.

    **Minimally Invasive Options**

    For more pronounced results, minimally invasive procedures offer a balance between effectiveness
    and recovery. Microneedling uses tiny needles
    to create channels in the skin, encouraging collagen production and
    skin regeneration. Thread lifts, using sutures
    to lift facial tissue, provide structural support, reducing sagging.

    **Microneedling: A Collagen-Boosting Marvel**

    Microneedling is a versatile treatment that boosts collagen, improving skin elasticity and
    texture. It’s often used on the face and neck for smoother results.

    **Thread Lifts: Lifting the Veil on Youthful Contours**

    Thread lifts offer immediate structural support, lifting and
    tightening facial tissue for a more defined look without major surgery.

    **Embracing Innovation in Minimally Invasive Treatments**

    Innovation in minimally invasive treatments continues
    to evolve, offering safer and more effective options. Advanced techniques ensure precise results with minimal discomfort.

    **Advanced Procedures**

    For those seeking more significant changes, advanced procedures like facelifts can address deeper lines and structural issues.

    Fat grafting adds volume back, rejuvenating both
    skin and structure.

    **Choosing the Right Path**

    Your path to smoother skin begins with understanding your unique needs
    and goals. Whether you prefer non-invasive or minimally invasive treatments, there’s an option tailored just for you.

    **Discover the Path to Timeless Beauty at Aesthetics MedSpa**

    At Aesthetics MedSpa, we specialize in providing personalized treatments that address each client’s individual needs.
    Our expert team uses cutting-edge techniques and advanced
    tools to deliver natural, youthful results.

    **Why Settle for Anything Less Than Perfection?**

    Why settle when you can achieve perfection? Each treatment is carefully crafted to give you the best possible
    outcome, ensuring your smile lines are smoothed out and your skin glows with health.

    **Step into Your Glow**

    Take the first step toward a more confident you. Embrace your
    glow and rediscover the radiance of youthful skin with treatments that work.

    **Related Posts**

    – Top 5 Non-Invasive Ways to Fight Wrinkles(#)
    – How to Maintain Your Skin After Treatments(#)
    – The Secret to Radiant Skin: Collagen and You(#)

    Explore these topics for more insights into achieving your best skin ever!

    my blog; doctor prescribed steroids (Carmela)

  2. Their degree 2 compression also helps with muscle recovery and rehabilitation. Plus, they have gel strips to lock the sleeves into place and assist forestall them from slipping
    down, which is particularly important when lifting heavy weights.
    Iron Bull Energy 7mm knee sleeves are an excellent option for athletes on the lookout for help and compression during weightlifting and powerlifting.
    They are made with high-quality neoprene, that includes a 3D contour design for
    a cosy, snug match. Knee sleeves are to not be confused
    with knee braces, which work to stabilise the joint and are usually used to offer help or
    limit movement while an harm heals. Whereas knee sleeves do supply support, they’re usually far more flexible, and in addition protect the knees from potential damage while permitting full
    vary of movement. This is the very first thing that you must care about when in search of the
    best knee compression sleeves.
    RDX K4 wraps comply with the OEKO-TEX® Normal 100, which guarantees that they are made from high-quality, non-hazardous,
    and sustainable materials. Furthermore, they’re approved to be used in World Powerlifting Congress competitions.
    Weightlifters/Powerlifters/Cross-trainers – as mentioned constantly throughout the article, people who
    do resistance coaching ought to deal with their knees.
    This primarily consists of weightlifters, powerlifters, and cross-trainers that lift frquently.
    Moreover, people whose jobs also involve lifting and carrying heavy objects, i.e.
    development workers, factory employees, movers, etc.
    Begin wrapping from the back of your knee, ensuring every wrap slightly overlaps the previous one.
    After the carry is full, it’s beneficial to launch the wraps and
    let the joint move freely, before retightening them on your
    next try.
    Plus, DonJoy® supplies support stage, exercise and harm suggestions that
    can assist you choose the knee brace for your wants.

    Store revolutionary designs just like the Reaction Internet Knee Brace or supported hinged braces like the Deluxe Hinged
    to assist manage your knee ache. From compression sleeves and
    patella bands to ACL bracing and custom knee braces, DonJoy®
    has it. The good factor about sporting knee sleeves is to offer the knee joints
    with heat and compression. As properly, the added compression will increase stability, which might help you carry more weight.
    Spandex, nylon, or polyester knee compression sleeves are used
    for extra non-lifting activities, similar to mountaineering or working.

    This is why you’ll see so many powerlifters wearing these two manufacturers.
    Generally with 5mm knee sleeves, the sleeve does not
    keep in place on the knee cap, and you’ll find yourself having
    to tug it up over the course of the workout. The Titan Yellow Jacket
    Knee Sleeve is among the most popular selections among lifters and is one of the best knee sleeve cash
    can buy for powerlifting. Let’s check out each of those
    knee sleeves in additional element so that you perceive the professionals and cons of every design. Every day
    is leg day, and I can always use all the
    assistance I can get to make it through.
    ‘However if you’re fairly new to weightlifting, I wouldn’t spend the money on knee sleeves
    just yet if there is no discomfort. In reality, early levels of lifting can help strengthen the knee joint,’ advises Opara.
    The finest knee sleeves will keep your muscular tissues and joints safe as you work out, plus help prevent
    accidents from sabotaging your health goals. Never worry — we have compiled an entire information to knee sleeves, including what they’re used for, when to wear them
    and the most effective pairs to buy now. When taking a look at the best
    knee sleeves, we first made positive the general high quality of the sleeve was there.
    You deserve to have the very best quality knee sleeve potential and the material and durability are what matter most, especially with the put
    on and tear and tear introduced on by train. We then look at the
    extra features like padding, total fit and really feel,
    and any other further bonuses that include the respective knee sleeve.

    Stop knee damage and ache from tendonitis, surgical procedure,
    and ACL tears with added help from our robust knee sleeves.
    If you want an immediate increase in efficiency on your subsequent personal record squat, get the RDX K4 weightlifting knee wraps.
    Made from extremely stretchable and breathable cotton, they’ll maintain your knees secure while remaining comfy to wear.
    Firstly, the warmth and compression stimulate blood circulate, muscle oxygenation, and venous return, maintaining the muscle tissue energetic and energy technology high.
    Knee sleeves are an accessory meant to aid your knees throughout physical exercise.
    As the name suggests, the “sleeve” is meant to enwrap the knee and supply 360-degree coverage.
    They’re produced from tightly woven but flexible supplies corresponding to Neoprene, as they’re meant to suit snugly
    around the knee.
    One of the vital thing issues to remember whenever
    you need to buy a knee brace for arthritis is that you must go for something that matches
    comfortably without leaving your knee inflexible. There are many different types of knee sleeves obtainable, so you will want to
    choose one that is finest suited for your individual wants.
    Our staff at Era Iron put together an inventory of the Finest Knee Sleeves for
    2025 to assist with your powerlifting, bodybuilding, and different lifting
    needs.
    It’s additionally quite supportive in comparison with most sleeves which, once more, makes it excellent for
    plus-sized dudes and dudettes. However, I wouldn’t say that is your
    best guess if you’re on the lookout for more
    knee help. Whereas it does supply some, moderately to severely unstable knees
    would doubtless want more. This means you’ll get effective ache and inflammatory reduction all around your knee and may put on the sleeves for lengthy hours with out it being uncomfortable.

    The Rehband 7mm Knee Sleeve is out there in a selection of colors, including black,
    pink, camo, purple, and blue. What I like about these sleeves, in particular, is the tapered
    bottom. This will present a bit extra suction to the calf muscle
    in order that the sleeve won’t slide down as quickly as
    you get sweaty. The Strong Knee Sleeve by Slingshot is gaining in reputation amongst many top-level powerlifters.
    There are presently three generations of the Titan Yellow Jack Knee Sleeve.

    Every generation has been made slightly more durable, which prevents put on and tear.

    So simply ensure you get the 3rd generation sleeve, or else you may run into some fraying
    points on the seams with intensive use.
    Clinical research strongly assist the significance of exercise for knee well
    being and pain discount. Transferring your knee often with a assist such because the AktivLife Knee Help has been confirmed to scale back pain and
    enhance mobility. The AktivLife makes use of materials
    that stretch and transfer with you, supporting dynamic activities.
    This characteristic permits you to preserve mobility and comfort,
    enhancing circulation and aiding within the restoration process.
    This expertise is engineered to mimic the pure support of wholesome knee function, offering stability and reducing
    pressure on your joints.
    MyCocoons are bulky, so they might not be greatest if you’d like a sleeve to put on beneath tight
    clothing. But, pair that with warmth or chilly and it’s nearly like taking your
    physical therapist with you wherever you go.
    It’s made with a mix of textiles that supply uniform compression, excellent breathability, and top-notch sturdiness.

    The unisex sizes vary from XS—XXXL, and it is out there in a wide range of
    colours, as properly.
    They will hold your knees warm but won’t help the knee joint,
    scale back joint pain beneath important load, or permit you to carry extra
    weight. For one, knee sleeves are much easier to slip on and
    off, whereas knee wraps require you to spend more time correctly encasing
    the joint in a wrap job that’s effective and sturdy.

    Additionally, knee sleeves are more accommodating to different movements —
    when wearing knee sleeves, you’re still capable of walk round or carry out dynamic workout routines
    depending on thickness. Knee wraps are designed for max tightness, basically preserving your legs in a straight position until under a heavy squat.
    This can also make for a less comfy training expertise if you depart the accessory on all through your whole workout.
    Sure, knee compression sleeves work properly if you buy a quality
    product and use the proper dimension. Knee compression sleeves will assist
    provide some light help, maintain your joints heat, improve blood flow, and help in serving to you recuperate
    faster.

    References:

    women who take steroids (oke.zone)

Leave a Reply

Your email address will not be published. Required fields are marked *