 |
 |
|
|
|
May/June, 2005
Mountain Medic
Backwoods Dislocation
By Jon Tierney, Acadia Mountain Guides Climbing School
Surfing your favorite hole and pop goes your buddy’s shoulder! Long-time boaters usually have a story or two about someone suffering a dislocated shoulder in a bad place. Knowing how to reduce such an injury will not only make the patient more comfortable and decrease the potential tissue damage but gain you hero status in their eyes.
Before muckling (check spelling) on and pulling for all you are worth take a good look at how they suffered the injury. Was it from a levering force applied at the hand such as catching the paddle behind a rock or was it from impact like falling over a waterfall and splaying out into the rocks below. If direct impact was the cause then only manipulate the dislocation if there are signs of decreased circulation, sensation, or motor function (CSM) in the arm or hand below the injury.
If the joint was levered out of it’s position or CSM is poor and you don’t have a hospital next door then an attempt should be made to reposition in the field.
Here is one simple method of shoulder reduction recommended in WMA wilderness medicine courses.
Assess the circulation in the arm.
Grasp the arm on the forearm just below the elbow and at the wrist. Pull gentle traction, as if you are pulling a ten pound bag of sugar across the floor, and have the person lie down. Alternatively if there is no good place to lie down, have someone else brace the patient’s chest from the opposite side so they don’t tip over as you pull. [diagram]
Now slowly bring the elbow away from the body until it forms a chicken wing ninety degrees to the body. Move in small increments using the patient’s level of discomfort as a measure and maintain a steady pull. [diagram]
Next, rotate the arm so that the hand moves upward into a baseball throwing position. Again, maintain traction and move in tolerable stages. [diagram]
Typically this procedure will cause the head of the humerus to move back into normal alignment with the shoulder bone. It may take only slight manipulation and a few seconds or the whole procedure could take over 10 – 15 minutes to accomplish.
Finally, bring the arm back across the chest and secure it with webbing in a x fashion or with a PFD. [diagram]
A follow-up visit to the ER is always a good idea just to have things checked out thoroughly, rule out any further damage and get you back on the river asap.
Have a medical question? E-mail the Mountain Medic.
Email nick [at] noumbrella [dot] com with your questions, comments and concerns.
Design and Content © 2002 to 2006 No Umbrella
