Re: [Paddlewise] Cliff Jacobson's dislocated shoulder remedy

Evan posted:
>Can anyone comment on the validity of this method?  If this really works, 
>this seems like a very worthwhile piece of information for
touring kayakers.<

The last issue of Sea Kayaker Magazine has a good primer on shoulder 
dislocation anatomy as a sidebar to a safety article by Doug Alderson 
regarding a local paddler who dislocated his shoulder in Baynes Channel off 
Victoria/Oak Bay (Gordin's fav haunt).

I've often wondered what I would do, both in a solo wilderness setting 
on-shore, or worse, an in-water (probably very rough water) shoulder 
dislocation scenario. The possibility of dislocating with an 
anterior-inferior dislocation and ending up in the water certainly makes a 
case for dressing for immersion as opposed to air temperature.

Not sure what I'd do to relocate if I was in the water. I might try to put 
my arm over the bow of the kayak, kinda like one would use the 
rock-under-the-arm relocation method, but the later is frowned upon by 
medical personal as it causes the arm to relocate too quickly (or suddenly 
may be the word I'm looking for). Though, I'd sure want to have my shoulder 
pop back in sooner than later, especially after reading Doug Alderson's 
descriptive phraseology about the world of pain one is thrust into. If I was 
still seated upright in my kayak, I'd have a hard time attempting the 
self-reduction technique my mountain biker friends suggest, where one clasps 
their hands around their ipsilateral knee, which is bent at 900 and 
subsequently leans backward to provide reduction of the injury. I say a hard 
time, because I'm in a tippy kayak with an Ocean Cockpit. Maybe that Keyhole 
Cockpit isn't such a bad idea afterall.

For on-shore situations where medical help was far removed and a 
self-reduction was being contemplated out of necessity, I might be tempted 
to down whatever relaxants and/or sleeping medication I had, after lying 
face down on a log using the relax/stretch/weighted arm pull method, and 
wait for spontaneous relocation as opposed to the self-help rotation and 
gentle self-pull methods. Heck, how about knocking yourself out with a good 
whack to the head. Then, asleep, there's a good chance of relocation. Of 
course, now we have a head injury to deal with (where that cordless, I need 
to drill a burr hole in my skull). Or, of course, there's the Mel Gibson 
method (probably not found in emergency medicine literature), where you just 
whack your dislocated shoulder against a door jam (or in this case, perhaps 
a tree or a 100 pound Nordkapp). I take it the name of the game with 
relocations is gentle, relaxed attempts, as opposed to anything severe or 
jerky (as usually portrayed in Hollywood movies).

More seriously, one could try to hold a tree or pole-like object with the 
offending arm, then move one's body away from the arm in an attempt at an 
anatomic reduction. Maybe one could just sit and cry, pray, meditate, and 
wait for it to relocate on its own. Me? I'd probably start swearing, kick my 
paddle, and curse my luck at being nominated for yet another Darwin Award. 
As I don't carry lidocaine with antiseptic injection capability, if I can't 
relocate I better be able summon help eventually, somehow. Fortunately, 
nature gifted me with a very tight shoulder anatomy, so dislocations are a 
remote possibility (believe me, I've tried to dislocate both shoulders many 
times), allowing me to pursue rougher water paddling on my own terms over 
the years . The down side is all that tight space creates a lot of 
impingement potential.

When I think about the complications that can arise from a dislocation, 
including neurovascular injury and possible (but rare) severe arterial 
damage and even loss of circulation,  not to mention a life threatening 
rescue scenario if in the water, one should do all they can to avoid 
potential for this injury. Work on those low braces.

Just a reminder that if you are attempting to help someone else who has a 
shoulder dislocation, the usual protocol is to say you know first aid, then 
offer assistance after receiving permission. If you have not been trained to 
provide the level of assistance you are wanting to give, make sure the 
victim understands your limitations. And, of course, if you are with your 
mates when one of them dislocates, yelling loudly at them about their bloody 
stupid high-brace isn't going to help them relax. Save that for after the 
post-reduction medical follow-up, when everything checks out okay again, and 
you can head off to the bar with your buds.

Doug Lloyd
Victoria BC
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