Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Managing Dislocated Shoulders

Nathan McNeil, MD published an article entitled “Postreduction Management of First-Time Traumatic Anterior Shoulder Dislocations” in Annals of Emergency Medicine (2009;53:811-813). This is an interesting article for emergency physicians that is very relevant for all practitioners of outdoor medicine, because the shoulder is the most commonly dislocated joint.

The subject is what to do with a shoulder that has been dislocated anteriorly (the head of the arm bone [humerus] has popped out of the joint in a forward direction) and then “reduced” (put back into the proper position). The most commonly practice technique for how to position the arm after a shoulder dislocation has been reduced in what is known as “internal rotation.” This would be the position of the arm if it is brought across the chest in a traditional sling.

Dr. McNeil reviewed the medical literature to draw a conclusion about how best to position the arm after a first-time shoulder dislocation in order to achieve the minimal number of recurrences (of dislocation). Based upon his review, he wrote that the currently available evidence suggests that the immobilization of a first-time traumatic (caused by injury) shoulder dislocation is external (not internal) rotation for 3 weeks. Furthermore, he found that there is little to no evidence that immobilization in internal rotation has any effect on recurrence.

Immobilizing the shoulder in external rotation requires deployment or creation of an external rotation immobilization brace. This is not a technique with which many doctors are familiar, so it would need to be specially taught to them, and certainly would require special training for laypersons.

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Preview the Annual Meeting of the Wilderness Medical Society, which will be held in Snowmass, Colorado July 24-29, 2009.

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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.