Dealing with Shoulder Dislocation in Doomsday

I find it so interesting that there is next to nothing in off-grid medicine references in regards to many common orthopedic injuries.  There was almost nothing on managing ankle sprains, one of the most common reasons people go to the ER or urgent care, and how to differentiate between bad sprains and fractures.  Likewise, I found very little on shoulder dislocations, and yet it also is somewhat common.  Survival and Austere Medicine, 3^rd Edition had a page describing two techniques.  The Ship’s Medicine Chest and Medical Aid at Sea advised doing nothing without instruction from a physician, except to administer morphine for pain.  So that makes me think treating a dislocated shoulder is going to be quite painful for the patient.  But it also provided the instructions that Dr. Steve shared in our class. 

See, one of the problems with the techniques described in Survival and Austere Medicine, 3^rd Edition is that I would have to have some upper body strength.  I have none.  Zero.  In discussing the problem of dislocated shoulders in our class, Dr. Steve said he’d have no problem being able to address a shoulder dislocation on me even if I appeared in his clinic days after the injury occurred.  At the same time, he pointed to an extremely beefy gentleman in the class who must have spent hours each day working out.  What he lacked in height (he was shorter than I) he made up for in upper body strength.  Dr. Steve said that if that guy showed up in his clinic with a dislocated shoulder, even right after it happened, he’d start crying.  And that’s because with dislocations, muscle spasms and swelling will begin soon after the injury, making it more difficult to slip bones back into place. 

The shoulder joint is the most unstable joint in the human body and relies on muscles, ligaments, and tendons for stability.  When it becomes dislocated, it’s pretty obvious and a little disturbing to look at, especially for the patient.  It’s painful.  So the first two things to do are to reassure the patient that it can be treated and to administer pain reliever. 

This technique of reducing a dislocated shoulder (that’s what it’s called when you put joints or bones back into place) can be done by almost anyone, regardless of physical strength.  Here are the verbatim instructions from The Ship’s Medicine Chest:

“A clove hitch bandage should be applied to the wrist on the side of the injury.  (See Fig. 3-30.)  Then the patient should be placed face down on a table with his shoulder and arm hanging over the side.  A bucket with 10-15 pounds of weight in it should be attached to the clove hitch.  (See Fig. 3-31.)  The weight of his arm and the additional weight of the bucket will gradually stretch the tight muscles about the dislocated joint and pull it back into position.  Often the dislocation will reduce in 10 to 15 minutes, but may require 30 minutes to one hour.”

Additional notes.  The clove hitch bandage referenced above could be approximated with a triangle bandage wrapped a few times around the wrist.  You want it to be nice and comfortable without digging into the patient’s flesh as it has to hold 10-15 pounds.  Also, the patient is pictured with his head on a pillow and another under his arm to make it more comfortable. 

After the shoulder is reduced, it should be placed in a sling and the patient should avoid using the arm unnecessarily for 72 hours and be very cautious with other movements for about 2 weeks. 

References:

The Ship’s Medicine Chest and Medical Aid at Sea, (1978), 80-81.

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