Wilderness First Aid: Shoulder Dislocation

How to deal with paddling's most common injury

Photo: Aaron Schmidt

Photo: Aaron Schmidt

By Grant Lipman

One of the most common dislocations is the shoulder. This is especially true for paddling. The following offers a simple breakdown of what a shoulder dislocation looks like and how to relieve it. This instructional is not a substitute for actual wilderness first aid training, which we highly recommend all paddlers pursue. 

All dislocations may be associated with a broken bone. Consider reducing a dislocation if you have specific training in the technique and if the patient is amenable to an attempt. Also, evaluate other factors, such as the time it will take to reach medical help, and whether the victim can get off the river by walking or riding in a raft, or whether they will have to paddle. In general, both the difficulty of reduction and the amount of long-term complications increase the longer you delay the attempt to reduce the dislocation. Always check CSM—circulation (pinking of nail bed after pressure should take < 3 sec), sensation (dull vs. sharp differentiation), and movement—and note if this changes after the reduction attempt. All dislocation/reduction attempts should be done with calm and reassuring voice, applying slow, gentle, and constant effort (traction). If you encounter pain or resistance, go slower, maintaining constant traction and calming voice.

Symptoms: Shoulder dislocation
- Loss of natural curve of shoulder (shoulder appears squared)
- Holding affected arm up and away from body
- Unable to touch unaffected (opposite) shoulder with the fingers of the injured arm.

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Appearance of dislocated shoulder

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Body position of a dislocated shoulder

 *Only attempt reductions if trained in the procedure and patient is amenable*

Treatment:
- Remove jewelry
- Assess CSM
- Reduce dislocation.
- If successful reduction, you will hear a “pop” and resolution of victim’s pain.
- Recheck CSM and sling arm.

Knee-wrap reduction technique

- Sit the injured person down with bent knees.
- Clasp both their hands around knees and have them lean back, slowly, until
shoulder spontaneously reduces.

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Shoulder reduction by knee-wrap technique

 

 

 

 

 

 

 

 

 

Tree-hug reduction technique

- Have the injured person wrap their arms around a slender tree (hugging it).
- Clasp both their hands around trunk and have them lean back, slowly, until
shoulder spontaneously reduces.

wilderness first aid

Shoulder reduction by tree-hug technique

 

 

 

 

 

 

 

 

 

 

wilderness first aidGrant S Lipman, MD, FACEP, FAWM is the clinical assistant professor of Surgery/Emergency Medicine at the Stanford University School of Medicine. He offers information on common paddling-related injuries and how to handle them. For more in-depth information, you can click here to purchase his print book The Wilderness First Aid book or a downloadable app. 

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  • nose dive king

    my doc told me that next time this happens to kneel on my fingers, “relax” and lean back gently. gives the added downward motion to correct things like severe anterior dislocations where the arm flips around like mine did

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