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From: kcd (k.c. dillon) <"kcd>
subject: [Paddlewise] dislocated shoulder remedy
Date: Sun, 12 Jun 2005 20:34:52 -0700
At 05:33 PM 12-06-05, you 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 think this is one of those "when all you have is a hammer, everything 
looks like a nail" things.  the shoulder (scapula) sits around & among 
several bones and can indeed get dislocated, but without knowing which 
bones, tendons, and ligaments are involved, the remedy could cause 
immensely more trouble.

here is a nerdly little URL to explain the types of dislocations.

http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=171&topcategory=Shoulder

i do ultrasound in a hospital, so most of my practice is not 
musculoskeletal, but visceral- - -but still, as a medical professional, 
considering the possible varieties of dislocation, this sounds like big 
trouble to me.

not that i'm intrepid of a kayaker to GET a shoulder dislocation (most 
likely), but if i were and did, i'd bind the shoulder to my side and get 
the hell back to civilization. obviously if you are by yourself in the 
wilderness this isn't gonna work. . . but the remedy mentioned has only a 
33% chance or thereabouts of working, either.

just my 2 cents.


Kathleen Comalli Dillon, BA, RDMS
Novato, CA 
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From: <rebyl_kayak_at_iprimus.com.au>
subject: RE: [Paddlewise] dislocated shoulder remedy
Date: Mon, 13 Jun 2005 21:40:42 +1000
Kathleen wrote: -
SNIP
>but without knowing which bones, tendons, and ligaments 
>are involved, the remedy could cause immensely more trouble.
and SNIP
>not that i'm intrepid of a kayaker to GET a shoulder dislocation 
>(most likely), but if i were and did, i'd bind the shoulder 
>to my side and get the hell back to civilization. 

G'Day,

My sentiments also Kathleen, except that where we paddle can be a very long
way from medical help. I'm told the sooner the shoulder can be relocated
the quicker the recovery and that it can take months to years for anything
like a full recovery. So it would be useful to have the relocation taught
somehow in a first aid course.

We've had a few dislocations in our club over the last year or two. They
all occurred in the surf, mostly during incorrectly executed high bracing.
It has happened to at least two members on more than one occasion so I suspect
that once dislocated a shoulder may be more susceptible. One of the victims
was a doctor and able to relocate their shoulder effectively - so it is possible
sometimes if one only knew how.

All the best, PeterO
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From: Michael Daly <mikedaly_at_magma.ca>
subject: RE: [Paddlewise] dislocated shoulder remedy
Date: Mon, 13 Jun 2005 10:37:10 -0400
On 13 Jun 2005 at 21:40, rebyl_kayak_at_iprimus.com.au wrote:

> >not that i'm intrepid of a kayaker to GET a shoulder dislocation
> >(most likely), but if i were and did, i'd bind the shoulder to my
> >side and get the hell back to civilization. 
> 
> G'Day,
> 
> My sentiments also Kathleen, except that where we paddle can be a very
> long way from medical help. I'm told the sooner the shoulder can be
> relocated the quicker the recovery and that it can take months to
> years for anything like a full recovery. So it would be useful to have
> the relocation taught somehow in a first aid course.

I just looked up my copy of Forgey's Wilderness Medicine book and he 
makes a number of comments about shoulder dislocations.  Significant 
is his statement that the sooner you relocate the shoulder, the 
better.  He identifies he anterior dislocation as being about ten 
times more likely than a posterior one and is treatable with the 
Stimson Method.  He points out that the Stimson Method puts less 
force on the shoulder than any other method and that is important if 
there are other injuries along with the dislocation.

When a friend of mine dislocated his shoulder while skiing, I was the 
first on the scene.  We got him to the hospital within a couple of 
hours and the doctor relocated the shoulder in seconds (when you know 
how, the technique is obviously easy!).  The doctor had asked him if 
he wanted a painkiller before proceeding and he said that he'd rather 
the shoulder be treated than wait for a painkiller to kick in.  The 
reduction of pain was described as immediate.  He told me that the 
pain was so bad that he'd do almost anything to have the shoulder 
treated rather than wait again.

So I think the message I got out of this, reading and First Aid 
courses I've taken is that you have to judge the situation.  If aid 
is feasible in a timely manner, binding and shipping the patient off 
to the hospital is a good idea.  However, if you can diagnose the 
dislocation as an anterior one (the books describe this) and the time 
to treatment is long, use the Stimson method and get the patient to 
professional help as soon as possible.

Mike
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