Modified Cunningham Technique for Anterior Shoulder Dislocation

NCT07652671 | Completed

• 1 other identifier: 775
• Study Type: interventional
• Target: 64
• Locations: 1 country
• Sites: 1

Brief Summary

Anterior shoulder dislocation is a common emergency condition that usually requires closed reduction in the emergency department. Several reduction techniques are used in clinical practice, and the ideal method should be effective, fast, easy to perform, well tolerated by the patient, and associated with a low need for sedation. This two-center prospective randomized study compares the standard Cunningham technique with a modified Cunningham technique in adult patients presenting to the emergency department with anterior shoulder dislocation. Eligible patients were randomly assigned to one of two groups: standard Cunningham technique or modified Cunningham technique. The main aim of the study is to compare the success rate of shoulder reduction between the two techniques. Secondary aims include comparing reduction time, pain level measured by the Visual Analog Scale, need for additional reduction maneuvers, need for sedation, emergency department discharge time, and procedure-related complications. The study is designed to determine whether the modified Cunningham technique can provide faster and more successful shoulder reduction without increasing patient discomfort or complication risk.

Conditions

Anterior Shoulder Dislocation; Closed Reduction; Modified Cunningham Technique

Keywords

Anterior Shoulder Dislocation; Closed reduction; Modified Cunningham technique; Emergency department; Shoulder dislocation

Outcome Measures

Primary Outcomes (1)

• Successful Shoulder Reduction Rate

  Success rate of anterior shoulder dislocation with modified Cunningham reduction technique

  1 hour

Secondary Outcomes (6)

• Reduction Time

  1 hour

• Procedure-Related Pain Score

  1 hour

• Need for Additional Reduction Maneuver

  1 hour

• Need for Procedural Sedation

  1 hour

• Emergency Department Discharge Time

  Procedure-Related Complications

Study Arms (2)

Standard Cunningham Technique

ACTIVE COMPARATOR

Participants in this arm underwent closed reduction of anterior shoulder dislocation using the standard Cunningham technique. The patient was placed in a seated position, and reduction was attempted through patient relaxation and massage of the biceps, deltoid, and trapezius muscles without forceful traction.

Procedure: Standard Cunningham Technique

Modified Cunningham Technique

EXPERIMENTAL

articipants in this arm underwent closed reduction of anterior shoulder dislocation using the modified Cunningham technique. The patient was placed in a seated position, and the affected hand was positioned on the volar aspect of the physician's elbow. The physician supported the patient's elbow and applied gentle downward pressure to the antecubital region while performing massage of the biceps, deltoid, and trapezius muscles to facilitate reduction without forceful traction.

Procedure: Modified Cunningham Technique

Interventions

Standard Cunningham Technique PROCEDURE

Closed reduction of anterior shoulder dislocation using the standard Cunningham technique. The participant is seated, the affected upper extremity is supported in adduction and elbow flexion, and the physician applies massage to the biceps, deltoid, and trapezius muscles to facilitate muscle relaxation and shoulder reduction without forceful traction.

Standard Cunningham Technique

Modified Cunningham Technique PROCEDURE

Closed reduction of anterior shoulder dislocation using the modified Cunningham technique. The participant is seated, and the affected hand is placed on the volar aspect of the physician's elbow. The physician supports the participant's elbow and applies gentle downward pressure to the antecubital region while performing massage of the biceps, deltoid, and trapezius muscles to facilitate reduction without forceful traction.

Modified Cunningham Technique

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age 18 years or older
• Presentation to the emergency department with acute anterior shoulder dislocation
• Diagnosis of anterior shoulder dislocation confirmed by clinical examination and radiographic imaging
• Conscious and cooperative patients who are able to comply with the seated reduction procedure
• No associated mechanical pathology such as fracture, open wound, laceration, foreign body, or other traumatic condition preventing closed reduction
• Ability to provide written informed consent for participation in the study

You may not qualify if:

• Refusal to participate in the study
• Missing or unavailable study data
• Posterior or inferior shoulder dislocation
• Fracture-dislocation or associated fracture
• Open shoulder injury or significant laceration
• Foreign body or other mechanical pathology involving the affected shoulder
• Neurovascular deficit requiring urgent surgical or orthopedic evaluation
• Multiple trauma
• Altered mental status or inability to cooperate during the procedure
• Previous surgery on the affected shoulder
• Unsuitability for reduction in the seated position
• Requirement for immediate procedural sedation before the first reduction attempt

Sponsors & Collaborators

• Antalya Health Sciences University: lead
• Akdeniz University Hospital: collaborator

Study Sites (1)

University of Health Sciences, Antalya Training and Research Hospital

Antalya, konyaaltı, 07100, Turkey (Türkiye)

Location

Related Publications (4)

• Cunningham NJ. Techniques for reduction of anteroinferior shoulder dislocation. Emerg Med Australas. 2005 Oct-Dec;17(5-6):463-71. doi: 10.1111/j.1742-6723.2005.00778.x.

  PMID: 16302939 BACKGROUND

• Cunningham N. A new drug free technique for reducing anterior shoulder dislocations. Emerg Med (Fremantle). 2003 Oct-Dec;15(5-6):521-4. doi: 10.1046/j.1442-2026.2003.00512.x.

  PMID: 14992071 BACKGROUND

• Riebel GD, McCabe JB. Anterior shoulder dislocation: a review of reduction techniques. Am J Emerg Med. 1991 Mar;9(2):180-8. doi: 10.1016/0735-6757(91)90187-o. No abstract available.

  PMID: 1994950 BACKGROUND

• Cutts S, Prempeh M, Drew S. Anterior shoulder dislocation. Ann R Coll Surg Engl. 2009 Jan;91(1):2-7. doi: 10.1308/003588409X359123.

  PMID: 19126329 BACKGROUND

MeSH Terms

Conditions

Emergencies; Shoulder Dislocation

Condition Hierarchy (Ancestors)

Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Joint Dislocations; Joint Diseases; Musculoskeletal Diseases; Wounds and Injuries; Shoulder Injuries

Study Officials

• MURAT DUYAN

  University of Health Sciences, Antalya Training and Research Hospital

  PRINCIPAL INVESTIGATOR

• SULEYMAN IBZE, ASSISTANT PROFESSOR

  Akdeniz universty

  STUDY CHAIR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Masking Details: No masking was applied. Due to the nature of the shoulder reduction techniques, both the treating physician and the participant were aware of the assigned intervention.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor of Emergency Medicine

Model Details: Participants were randomly assigned in a 1:1 ratio to undergo closed reduction using either the standard Cunningham technique or the modified Cunningham technique.

Study Record Dates

• First Submitted: June 8, 2026
• First Posted: June 17, 2026
• Study Start: December 1, 2024
• Primary Completion: June 1, 2026
• Study Completion: June 5, 2026
• Last Updated: June 17, 2026

Record last verified: 2026-06

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)