Dealing with a shoulder dislocation

 
  • Face planting off a mountain bike?

  • Taking a hard fall while skiing or snowboarding?

  • Getting your shoulder yanked kayaking on a whitewater river?

  • Feet blowing off when crack climbing or ice climbing, and your weight falling onto your well buried ice tool or thumb down hand jam?

  • Shoulder getting pulled when trying to self arrest with an ice axe?

These are all consequences of having fun in the mountains, and they are also all things that can easily lead to a dislocated shoulder. Chances are pretty high that sometime in your outdoor career you're going to have to deal with one, either yours or somebody else's. (And yes, I have some personal experience with number three and four listed above!)

Knowing how to diagnose, examine, reduce, and splint this injury can be extremely important in the backcountry, taking a situation from an “immediate evacuation” to “minor pain and great relief” in literally a few minutes. I think this is something every backcountry user should be familiar with, but often it’s not taught in entry level wilderness first aid classes.

Well good news, because this terrific video series from the MedWild YouTube channel walks you through every step. (The splinting technique shown in the last video is especially clever.)

There are several field techniques that work to reduce a dislocated shoulder. The one shown below is simple and effective.


Note that the examination portion of this process is very important, as is the mechanism of injury (MOI).

If the MOI involves a traumatic sort of fall, such as bike crash, there's a chance that there can be some broken bone involved, which can complicate reducing the shoulder. This is mentioned in video number three. If you do have an impact sort of injury and possible broken shoulder, it might be best to evacuate and not reduce the shoulder, because reducing the broken shoulder over a small chip of bone could cause problems. This is why, in a hospital setting, an X-ray is almost always done before a dislocated shoulder is reduced, to determine if it's a shoulder fracture, dislocation or hopefully not both.

However, if the injury comes from something less impactful, like big whitewater pulling your kayak paddle, or crack climbing with your hand thumb down and having your feet blow out, (me on both), it's probable that there is no underlying bone chips or other damage, and a simple reduction technique as shown in this video is going to solve your problem quite quickly.

Also, there is a possibility for nerves to be compromised in a shoulder dislocation. As mentioned in video number two, an important part of the patient exam is testing for good CSM (Circulation, Sensation, and Movement). This means a good pulse at the wrist of the affected arm, proper blood perfusion to all of the fingers, and for good sensation and movement in all of the fingers.

And, here is a direct quote from the video producers: “The distal neurological exam is mostly done to protect yourself from being blamed for any neurovascular compromise following the reduction. If you speak with the patient about it prior, or preferentially document it, there will be no question that any deficit was due to the injury and not the reduction. Neruovascular injury is virtually always due to the traumatic injury itself and not the reduction procedure.”

The big question is how close are you to a medical facility? If you can protect the injured shoulder as best you can and be in a medical facility within a few hours, it might be best to walk out and have them take care of it. But, if you're in a more remote location, knowing these proper steps could really help you out.

Watch these videos carefully, learn the steps, and take a wilderness medicine class.

 

Video 1 - Shoulder dislocations, field diagnosis (2:17)

 

Video 2 - Dislocated shoulder exam (2:25)

 

Video 3 - How to reduce a dislocated shoulder (5:07)

 

Video 4 - shoulder splinting (2:54)