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From: Evan Dallas <evand_at_pensionresourcegroup.com>
subject: [Paddlewise] Cliff Jacobson's dislocated shoulder remedy
Date: Thu, 09 Jun 2005 22:46:11 -0700
In the first-aid section of Cliff Jacobson's camping book ("Camping's 
Top Secrets", I think), he discusses a method for treating a dislocated 
shoulder where the injured person lays on his/her stomach on an elevated 
flat surface (like a large rock or a log) with a 5-10 pound weight tied 
to the the wrist and the arm hanging straight down.  Supposedly, after a 
while, the weight is supposed to allow the shoulder to reset itself.  He 
describes the method as "foolproof".

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.

Evan Dallas
Woodinville, Washington
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From: Michael Daly <mikedaly_at_magma.ca>
subject: Re: [Paddlewise] Cliff Jacobson's dislocated shoulder remedy
Date: Fri, 10 Jun 2005 11:22:57 -0400
On 9 Jun 2005 at 22:46, Evan Dallas wrote:

> 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.

I've no experience with it, but the Stimson Method is taught in many 
first aid books.  Apparently one of the key features of the technique 
is that leaving the injured party there for a while allows the 
muscles around the joint to relax.  When the injury happens, the 
muscles tend to tense up and given how painful the separation can be, 
the casualty has a hard time letting it relax.  Once the muscles 
relax, the joint pulls itself into alignment.

If it doesn't pop back in on its own, you can "turn the arm gently 
outward (thumb rotating outward, palm toward head) as you remove the 
weight" (quote from Wayne Merry's Official Wilderness First Aid 
Guide).  Once reseated, the joint should not be used until the 
injured person sees a doctor.

By the way, 5-10 lb sounds too light.  Merry suggests 10kg (22lb).

Mike
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From: RICHARD CULPEPER <culpeper_at_tbaytel.net>
subject: Re: [Paddlewise] Cliff Jacobson's dislocated shoulder remedy
Date: Fri, 10 Jun 2005 18:34:09 -0400
Evan Dallas wrote:   . . . treating a dislocated shoulder . . . lays on his/her stomach  . 
. . 5-10 pound weight tied to the wrist and the arm hanging straight down . . . 
"foolproof".

No, it is not foolproof, but it is as good as you are going to get.

We tried this once on the Kipawa.  Dave had a very long and nasty swim in some IV on 
Buttonhook, which among other things, dislocated his shoulder.  (He said that he was 
portaging, so I was surprised to have to fish him.)  One of the other paddlers was an 
emergency room physician, who laid him out on this stomach along an elevated log, and 
weighted his dangling arm.  After over an hour, the shoulder still did not go back in.  The 
physician said that Dave was too tense, and that drugs would be needed to relax him before 
the shoulder would go back in.  We didnt have any muscle relaxants with us (or any other 
drugs), so we had to bind up Dave and evacuate him.

Thats when thing got interesting.  We had get Dave to the other side of the river before we 
could walk him out.  He was in no condition to try to hang on to a boat, and he figured that 
he could simply sit in his boat while we towed him across.  We tried it, but a whirlpool 
caught him and dumped him.  Ill never forget the look on his face looking up from under the 
surface.  To make matters worse, when I laid back and pulled him out, I grabbed the rope 
with which we had bound his shoulder and arm, so we went round the whirlpool a few times 
with him in quite a bit of pain before I was able to get a proper grip on him.  Another boat 
then pulled my boat across while I held on to Dave and tried to keep his face out of the 
water.  He took in a lot of water, but kept pretty calm.


Richard Culpeper
http://my.tbaytel.net/culpeper/
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From: Joyce Family <tfj4_at_comcast.net>
subject: Re: [Paddlewise] Cliff Jacobson's dislocated shoulder remedy
Date: Fri, 10 Jun 2005 22:10:49 -0500
"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."
_________________________

This is the Stimson method recommended by Dr. Forgey in his book on
Wilderness Medicine.

Tom
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From: Doug Lloyd <dalloyd_at_telus.net>
subject: Re: [Paddlewise] Cliff Jacobson's dislocated shoulder remedy
Date: Mon, 13 Jun 2005 00:17:09 -0700
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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