Comparison of ultrasound-guided joint reduction with traditional methods in the emergency center

Abstract

Objectives: This study aimed to compare and analyze the reliability of ultrasound-guided procedures and traditional methods in the reduction of joint dislocations in the emergency department.

Methods: A total of 136 cases were included in the prospective randomized controlled study. The cases were randomized into groups as ultrasound-guided reduction (n=66) and traditional reduction (n=70). The reduction success, time spent for the procedure, complication rates, pain scores and patient satisfaction levels were evaluated. Functional results and osteoarthritis development were also analyzed in long-term follow-up. Chi-square test, Student t-test and Mann-Whitney U test were used in the statistical analysis of the data.

Results: The success rate in the ultrasound reduction group (93.9%) was significantly higher than in the conventional reduction group (71.4%) (P<0.001). The mean reduction time was calculated as 3.2±1.8 minutes in the ultrasound group and 7.6±4.1 minutes in the conventional group (P<0.001). Complication rates were 7.6% in the ultrasound group and 21.4% in the conventional group (P=0.018). While 90.9% anatomical position was achieved in the ultrasound group in post-reduction, this rate remained at 64.3% in the conventional group (P<0.001). In the long-term follow-up, osteoarthritis development (ultrasound: 15.2%, conventional: 35.7%, P=0.012) and functional limitation rates (ultrasound: 10.6%, conventional: 25.7%, P=0.021) were significantly lower in the ultrasound group.

Conclusions: Ultrasound-guided interventions in the reduction of joint dislocations in the emergency department provide higher success rates, shorter treatment times, and lower complication rates than traditional methods. Long-term results also support the superiority of reductions performed with ultrasound guidance. In light of these findings, ultrasound-guided reduction is recommended as the first-line approach in the management of joint dislocations.

Keywords

• Joint dislocation
• ultrasound
• reduction
• emergency department
• point-of-care ultrasound

References

1. 1. Selame LAJ, Matsas B, Krauss B, Goldsmith AJ, Shokoohi H. A Stepwise Guide to Performing Shoulder Ultrasound: The Acromio-Clavicular Joint, Biceps, Subscapularis, Impingement, Supraspinatus Protocol. Cureus. 2021;13(9):e18354. doi: 10.7759/cureus.18354.
2. 2. Gottlieb M, Patel D, Marks A, Peksa GD. Ultrasound for the diagnosis of shoulder dislocation and reduction: A systematic review and meta-analysis. Acad Emerg Med. 2022;29(8):999-1007. doi: 10.1111/acem.14454.
3. 3. Wu J, Zhang T, Li X, Dan Q, Zhang D. A Comparative Study on the Diagnostic Value of CTA and MRA in Anterior Dislocation of Shoulder. Comput Math Methods Med. 2022;2022:9461236. doi: 10.1155/2022/9461236.
4. 4. Cui DD, Long Y, Yan Y, et al. Three-Dimensional Magnetic Resonance Imaging Fast Field Echo Resembling a Computed Tomography Using Restricted Echo-Spacing Sequence Is Equivalent to 3-Dimensional Computed Tomography in Quantifying Bone Loss and Measuring Shoulder Morphology in Patients With Shoulder Dislocation. Arthroscopy. 2024;40(6):1777-1788. doi: 10.1016/j.arthro.2023.12.016.
5. 5. Mati B, Silver MA. Diagnosing and Treating an Acute Anterior Shoulder Dislocation Using Point-of-Care Ultrasound in an Urgent Care Setting. Perm J. 2022;26(3):135-138. doi: 10.7812/TPP/21.208.
6. 6. Chu KCW, Huang WC, Hsu CW, Hsu YP. Shoulder Dislocation Diagnosis: Do Not Overlook Clinical Examination in Favor of Point-of-Care Ultrasonography. Ann Emerg Med. 2020;76(2):248-249. doi: 10.1016/j.annemergmed.2020.04.018.
7. 7. Gonai S, Miyoshi T, da Silva Lopes K, Gilmour S. An umbrella review of systematic reviews and meta-analyses for assessment and treatment of acute shoulder dislocation. Am J Emerg Med. 2025;87:16-27. doi: 10.1016/j.ajem.2024.09.060.
8. 8. Attard Biancardi MA, Jarman RD, Cardona T. Diagnostic accuracy of point-of-care ultrasound (PoCUS) for shoulder dislocations and reductions in the emergency department: a diagnostic randomised control trial (RCT). Emerg Med J. 2022;39(9):655-661. doi: 10.1136/emermed-2020-210947.

9. 9. Owusu-Akyaw KA. CORR Insights®: Is Ultrasound-guided or Landmark-guided Intra-articular Lidocaine Injection More Effective for Pain Control in Anterior Shoulder Dislocation Reduction? A Randomized Controlled Trial. Clin Orthop Relat Res. 2024;482(7):1208-1209. doi: 10.1097/CORR.0000000000003020.
10. 10. Rungsinaporn V, Innarkgool S, Kongmalai P. Is Ultrasound-guided or Landmark-guided Intra-articular Lidocaine Injection More Effective for Pain Control in Anterior Shoulder Dislocation Reduction? A Randomized Controlled Trial. Clin Orthop Relat Res. 2024;482(7):1201-1207. doi: 10.1097/CORR.0000000000002936.
11. 11. Gawel RJ, Grill R, Bradley N, Luong J, Au AK. Ultrasound-Guided Peripheral Nerve Blocks for Shoulder Dislocation in the Emergency Department: A Systemic Review. J Emerg Med. 2023;65(5):e403-e413. doi: 10.1016/j.jemermed.2023.05.021.
12. 12. Omer T, Perez M, Berona K, et al. Accuracy of Landmark-guided Glenohumeral Joint Injections as Assessed by Ultrasound in Anterior Shoulder Dislocations. West J Emerg Med. 2021;22(6):1335-1340. doi: 10.5811/westjem.2021.3.50266.
13. 13. Mohanty CR, Gupta A, Radhakrishnan RV, Singh N, Patra SK. Ultrasound-guided low-volume anterior suprascapular nerve block for reduction of anterior shoulder dislocation in the emergency department: A case series. Turk J Emerg Med. 2023;23(4):254-257. doi: 10.4103/tjem.tjem_319_22.
14. 14. Gottlieb M. Shoulder Dislocations in the Emergency Department: A Comprehensive Review of Reduction Techniques. J Emerg Med. 2020;58(4):647-666. doi: 10.1016/j.jemermed.2019.11.031.
15. 15. Ladd LM, Crews M, Maertz NA. Glenohumeral Joint Instability: A Review of Anatomy, Clinical Presentation, and Imaging. Clin Sports Med. 2021;40(4):585-599. doi: 10.1016/j.csm.2021.05.001.
16. 16. Inoue J, Takenaga T, Tsuchiya A, et al. Ultrasound Assessment of Anterior Humeral Head Translation in Patients With Anterior Shoulder Instability: Correlation With Demographic, Radiographic, and Clinical Data. Orthop J Sports Med. 2022;10(7):23259671221101924. doi: 10.1177/23259671221101924.
17. 17. Gibbons RC, Zanaboni A, Genninger J, Costantino TG. Ultrasound-versus landmark-guided medium-sized joint arthrocentesis: A randomized clinical trial. Acad Emerg Med. 2022;29(2):159-163. doi: 10.1111/acem.14396.
18. 18. Lahr R, Wheeler F, Espinosa J, Lucerna A, Schuitema H. Use of Handheld Bedside Ultrasound to Confirm Successful Reduction of an Anterior Shoulder Dislocation. Cureus. 2024;16(1):e52089. doi: 10.7759/cureus.52089.
19. 19. Hunter M, Mackenzie M, Packer N. Does musculoskeletal ultrasound play a role in diagnosing and managing shoulder dislocations? CJEM. 2021;23(4):463-465. doi: 10.1007/s43678-021-00141-8.
20. 20. Dasburg KA, Vincent KR. Use of Point of Care Ultrasound during Shoulder Reduction. Curr Sports Med Rep. 2020;19(11):449-450. doi: 10.1249/JSR.0000000000000767.
21. 21. Shapla SP, Rahman MM, Paul P, et al. Usefulness of Diagnostic Ultrasound for Detection of Common Shoulder Abnormalities Prior to MRI. Mymensingh Med J. 2024;33(1):16-22.
22. 22. Zhou R, Prasad G, Robinson S, Shahane S, Sinha A. The significance of urgent ultrasound scan for shoulder dislocation in patients above the age of 40: A prospective British Elbow and Shoulder Society pathway implementation study. Shoulder Elbow. 2021;13(3):303-310. doi: 10.1177/1758573220913285.
23. 23. Henneberry R, Dahn T, Atkinson P. Just the Facts: Point-of-care ultrasound in the management of shoulder dislocations. CJEM. 2020;22(3):287-290. doi: 10.1017/cem.2020.14.
24. 24. Baah NO, Sharma AK. Shoulder Joint. J Emerg Nurs. 2020;46(5):711. doi: 10.1016/j.jen.2020.04.013.
25. 25. Mohanty CR, Singh N, Das S, Radhakrishnan RV. Re: Ultrasound-guided interscalene block versus intravenous analgesia and sedation for reduction of first anterior shoulder dislocation. Am J Emerg Med. 2022;58:347-348. doi: 10.1016/j.ajem.2022.04.015.