----- Original Message -----
From: "Paul Ransom"
Subject: Re: Flumazenil, Sedation and Fits
> For those of us out of the country last year, or having an off day during
> that posting, what exactly is the 'Belsham technique'? I remain to be
> convinced about the analgesia free reduction.
OK here goes, it's actually Kocher's original technique described in the
late 19th century and Phil loves to show me the original German transcript!
Firstly, NO traction allowed.
Hold the flexed elbow close to the patient's side i.e. adducted with the
forearm pointing to the roof (supine patient).
Then slowly externally rotate the humerus - this bit takes ages - all the
while keeping that elbow close to the patient's side.
When the forearm reaches the horizontal position (i.e. the humerus is now 90
degrees externally rotated), slowly flex the humerus, keeping the forearm
externally rotated throughout.
At full flexion of the humerus, you should now internally rotate the arm,
and lo and behold the joint is back in!
It's a bizarre experience, cos you can't really see where or when the
reduction occurred. I think you need an intact humeral head for it i.e. no
fractures allowed. Phil will let us know anything I've missed out, I'm sure,
and he's got some neat pictures describing the anatomical basis of the
technique. I'm not so patient so I sometimes use a little sedation/analgesia
but I still like the technique itself - it's very "drug sparing" so to
speak.
Adrian Fogarty
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