Joint Reduction Techniques with Dr. Gannon Sungar

We're gonna spend about 30 minutes talking about reduction techniques.

When we think about reduction techniques, there are essentially innumerable techniques, and this is really driven home with shoulder reductions.

I suspect if I surveyed everybody in this room, what is their favorite technique, they would describe something that maybe or maybe does not have a name.

each of us would probably have a different approach.

So the goal here is not to be comprehensive.

The goal here is to expose us to a couple different techniques that may kind of add to your armamentarium as you approach patients presenting in the emergency department with joint dislocations.

We're gonna focus on three main joints, mandible, shoulder, and hip, and we'll get started with mandible.

So just a little bit about the mechanism for mandible dislocations.

So the vast majority of these are atraumatic.

These tend to be pretty mild mechanisms.

So often these can be associated with significant mouth opening.

So yawning, taking a big bite of a sandwich, laughing, so pretty mild mechanisms.

And what happens is you get inferior and anterior dislocation of the mandibular condyle relative to the temporal bone.

And about 85% of these are bilateral.

The remaining 15% are just unilateral.

So these patients will present with their mouth stuck open and you'll be like just close your mouth and they're like i can't you know just just stop just close your mouth and they can't and that's because their jaw is dislocated and so Avery just walked in.

Avery and I were in residency together.

I don't know if Avery remembers this, but there was a woman in our residence at the University of Colorado during our residency time that probably taught like an entire generation of physicians how to reduce jaws because she dislocated like, I don't know, every five or six days.

And either she had really poor anatomy or she really liked propofol or maybe both.

But I don't know if you remember that.

We did a lot of these.

And the way I learned back in 2012 how to reduce a mandible was this traditional intraoral technique.

Who's done this technique? Okay, a lot of hands.

So this is quite old, originally described in the early 1900s.

And essentially, the provider will insert their bilateral thumbs onto the buccal mucosa of the mandible.

We're gonna spend about 30 minutes talking about reduction techniques.

When we think about reduction techniques, there are essentially innumerable techniques, and this is really driven home with shoulder reductions.

I suspect if I surveyed everybody in this room, what is their favorite technique, they would describe something that maybe or maybe does not have a name.

each of us would probably have a different approach.

So the goal here is not to be comprehensive.

The goal here is to expose us to a couple different techniques that may kind of add to your armamentarium as you approach patients presenting in the emergency department with joint dislocations.

We're gonna focus on three main joints, mandible, shoulder, and hip, and we'll get started with mandible.

So just a little bit about the mechanism for mandible dislocations.

So the vast majority of these are atraumatic.

These tend to be pretty mild mechanisms.

So often these can be associated with significant mouth opening.

So yawning, taking a big bite of a sandwich, laughing, so pretty mild mechanisms.

And what happens is you get inferior and anterior dislocation of the mandibular condyle relative to the temporal bone.

And about 85% of these are bilateral.

The remaining 15% are just unilateral.

So these patients will present with their mouth stuck open and you'll be like just close your mouth and they're like i can't you know just just stop just close your mouth and they can't and that's because their jaw is dislocated and so Avery just walked in.

Avery and I were in residency together.

I don't know if Avery remembers this, but there was a woman in our residence at the University of Colorado during our residency time that probably taught like an entire generation of physicians how to reduce jaws because she dislocated like, I don't know, every five or six days.

And either she had really poor anatomy or she really liked propofol or maybe both.

But I don't know if you remember that.

We did a lot of these.

And the way I learned back in 2012 how to reduce a mandible was this traditional intraoral technique.

Who's done this technique? Okay, a lot of hands.

So this is quite old, originally described in the early 1900s.

And essentially, the provider will insert their bilateral thumbs onto the buccal mucosa of the mandible.