analgesic positions

What are the analgesic positions?

These are positions that for Type I (SC) and Type II (SG) presentations allow you to position the patient's affected limb in a way that reduces stretch on the capsule. This reduces the visceral pain stimulus (deep, nauseating, vagal stimuli) and is likely to improve cooperation with your chosen technique.

It also gets you to the best starting position for your adduction (Type I) or Zero position (Type II) injuries and means that you will have to move the limb as little as possible.

Check in with your patients as to the comfort and pain scores once you have control of the limb, if they have much higher than expected discomfort then there may be something else going on (fracture, large amounts of pain/spasm) and you should stop, provide analgesia/sedation, and gather more information about the injury (XR).

The joint capsule is a membranous, fluid filled envelope that surrounds the glenohumeral joint. It is strengthened in some areas by ligaments that help to stabilise the joint. The button below links to a video discussing the anatomy of Analgesic Position 1

Anatomy of Analgesic Position 1

Analgesic Position 1 - for Type I (Subcoracoid) injuries

Sit your patient up (without slouching, towel or pillow down spine)

‘Hold’- take control of the affected limb with a 'hold.' This is a firm steady downward hold (not a pull) designed to move the humeral head towards where it needs to be, taking off some of the stretch from the capsule (reducing pain), and providing confidence to the patient that you have taken control of the limb. Once you are in this position, it can be useful to ask the patient their pain level, and explain again what you are going to do. It’s important to note that the elbow is not being supported from below, but is being placed in a downwards ‘hold’.

The affected arm is adducted (next to the body) and the elbow fully flexed (optimally shortens the biceps muscle, allowing full relaxation)

The humerus points directly down and should be in a neutral position (no forward flexion or external rotation)

Ask the patient to “shoulders back, chest out.” (reducing scapular anteversion and so reducing the static obstruction of the glenoid rim).

Kneel next to your patient and place your wrist onto their forearm, with their hand resting on your shoulder.

Sometimes once you have your analgesic position in place, the shoulder will reduce without any further moves. See how in this video (‘cunningham technique positioning.’)

Analgesic Position 1

Analgesic Position 1 - Tutorial

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Analgesic Position 1 - tutorial

Analgesic position 2

Analgesic Position 2 - for Type II (Subglenoid) injuries

Analgesic position 2 – move the arm to the position of most comfort for them, with a ‘hold.’ This is a firm steady axial hold (not a pull) designed to move the humeral head towards where it needs to be, taking off some of the stretch from the capsule (reducing pain), and providing confidence to the patient that you have taken control of the limb. Once you are in this position, it can be useful to ask the patient their pain level, and explain again what you are going to do.