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Legg Reduction Maneuver for Patients With Anterior Shoulder Dislocation

David D. Dyck, Jr, DO

Nicholas W. Porter, DO
Brett D. Dunbar, DO

Few manual techniques for reducing anterior shoulder dis- Recognizing Anterior Shoulder Dislocation
locations are easy to perform in the clinical setting, and A patient who has an anterior shoulder dislocation typically
many of these techniques require sedation. The authors presents to the family physician with an obvious deformity.2
describe a technique, the Legg reduction maneuver, that is Physical examination of the patient reveals a prominent
easy to perform on site and requires no premedication. Clin- acromion process and an anteriorly displaced humeral head,
ical experience indicates that proper use of this maneuver can resulting in a loss of the natural contour of the shoulder. There
successfully relocate a patient’s anterior shoulder dislocation. will also often be marked swelling of the shoulder, and the
The relocated arm can then be placed in an immobilizer patient will usually complain of pain, especially associated
and receive further medical management as appropriate. with motion. Classically, the patient will support the injured
The Legg reduction maneuver allows the physician to work arm with the unaffected limb, keeping the arm in external
with the natural tendencies of muscle groups in the patient, rotation and slight abduction.
rather than against them. Thus, the technique can be per- The physician should conduct a neurovascular examina-
formed without sedation. In addition, because no traction is tion before and after any reduction of an anterior shoulder
placed on the injured shoulder, the potential for neurovas- dislocation.3 If the reduction is successful, the patient should
cular injury is decreased. experience immediate relief of pain, and the natural contour
J Am Osteopath Assoc. 2008;108:571-573
of the shoulder should be restored. If the patient is able to
place the hand of the affected limb on the opposite shoulder
comfortably, it is quite likely that the reduction maneuver

T he shoulder has the greatest range of motion of any joint

in the human body. As such, it is one of the most com-
monly injured joints. Anterior shoulder dislocation is an
was effective.3

Legg Reduction Maneuver

injury that is frequently encountered by physicians treating The reduction maneuver described in the present report is
patients who have had acute trauma, such as injuries from named for William J. Legg, DO. Dr Legg developed this tech-
contact sports, occupational hazards, and motor vehicle nique in the mid-1980s and used it successfully to treat athletes
crashes. on sports field sidelines and patients in the emergency depart-
Various techniques have been described in the literature ment throughout his lengthy career as an osteopathic physi-
for reducing anterior shoulder dislocations.1 However, few cian in family practice.
of these techniques are easy to perform in the clinical setting, Dr Legg is currently retired from active practice but con-
and many require patient sedation. The “Legg” reduction tinues to instruct medical students at the Kansas City Uni-
maneuver technique described in the present report, by con- versity of Medicine and Biosciences in Mo.
trast, is easy to perform on site and requires no premedication
of patients. Maneuver Methods
Two practitioners are required to apply the Legg technique
with a patient—one osteopathic physician to perform the
reduction and one assistant to stabilize the unaffected shoulder.
The application of the technique involves the following steps:
From the Medical Center of Independence and Mid-America Sports Medicine
and Wellness in Independence, Mo (Dr Dyck); Arkansas Children’s Hospital in 1. The patient is seated in a straight-backed chair to minimize
Little Rock (Dr Porter); and Henry Ford Macomb Hospital in Clinton Town- movement of the upper body.
ship, Mich (Dr Dunbar).
Address correspondence to David D. Dyck, Jr, DO, Medical Center of
2. The assistant stabilizes the patient’s uninjured shoulder by
Independence, 19550 E 39th St, Suite 419, Independence, MO 64057-2307. applying slight downward pressure. This stabilization must
E-mail: [email protected] be maintained throughout the procedure.
Submitted May 31, 2007; revision received December 12, 2007; accepted
3. The patient is instructed to abduct the injured arm to an
December 28, 2007. angle of 90° to the body, if he or she is able to do so (Figure 1).

Dyck et al • Special Communication JAOA • Vol 108 • No 10 • October 2008 • 571

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and teres minor. Flexion of the elbow acts to reduce

tension on the coracobrachialis and bicep muscles.
The actual reduction occurs with adduction
and internal rotation of the arm, using the sub-
scapularis and latissimus dorsi muscles to assist in
the relocation.

Conclusion
In performing the Legg reduction maneuver, the
physician works with the natural tendencies of
muscle groups in the patient, as opposed to
working against them. This is the aspect of the
technique that allows it to be performed without
patient sedation. In addition, the technique requires
no traction to be placed on the injured shoulder,
decreasing the potential for neurovascular injury.
The Legg reduction maneuver is a clinically useful
technique for treating patients who have anterior
shoulder dislocation.
Figure 1. In the Legg reduction maneuver, the injured arm is first
abducted to a 90° angle to the body. After this step is complete, the
injured arm can be rotated externally so that the palm is facing for-
ward.

If the patient is unable to perform this movement, the physi-

cian may provide assistance.
4. The physician rotates the arm externally, such that the
patient’s palm is facing forward.
5. The physician flexes the patient’s elbow to a 90° angle
(Figure 2).
6. The physician ascertains that the abducted elbow and
forearm are maintained behind a coronal plane passing
through the patient’s occiput (Figure 3).
7. The arm is adducted toward the patient’s side, fully flexing
the elbow (Figure 4).
8. The patient is asked to actively internally rotate the arm
across the chest (Figure 5).

Comment Figure 2. In the next step of the Legg reduction maneuver, the arm
After the Legg technique is performed properly, the patient’s is flexed to a 90° angle at the elbow.
dislocated shoulder should relocate. If the procedure is unsuc-
cessful, it can be attempted again, making sure that the unaf-
fected shoulder is firmly stabilized. The relocated arm can References
then be placed in an immobilizer and additional medical man- 1. Ufberg JW, Vilke GM, Chan TC, Harrigan RA. Anterior shoulder dislocations:
beyond traction-countertraction. J Emerg Med. 2004;27:301-306.
agement can be provided as appropriate.
The Legg reduction maneuver is effective because it 2. DeLee JC, Drez D, Miller MD. DeLee & Drez’s Orthopaedic Sports Medicine:
Principles and Practice. Vol 1. 2nd ed. Philadelphia, Pa: WB Saunders;
involves motions specifically designed to neutralize the various 2003:1026-1027.
muscle groups that tend to resist shoulder relocation. By
3. Roberts JR, Hedges J. Clinical Procedures in Emergency Medicine. 4th ed.
abducting the arm, tension on the supraspinatus and deltoid Philadelphia, Pa: WB Saunders; 2004:949,957-958.
muscles is relaxed. External rotation reduces tension on the
chief external rotators of the rotator cuff—the infraspinatus

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Figure 3. In the next step of the Legg reduction maneuver, the Figure 4. In the next step of the Legg reduction maneuver, the arm
abducted elbow and forearm are maintained in a position that is pos- is adducted toward the patient’s side while fully flexing the elbow.
terior to the occiput.

Figure 5. In the final step of the Legg reduction maneuver, active

internal rotation of the arm and adduction of the arm effect reduc-
tion of the dislocated shoulder.

Dyck et al • Special Communication JAOA • Vol 108 • No 10 • October 2008 • 573