Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

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Wilderness and Rescue Medicine

encourage the muscles and the patient to relax and allow the humeral head to slip back into place against the glenoid. It is the most benign shoulder reduction technique and is worth a few minutes of trial before moving on to manipulation. This principle can be applied in almost any position, but sitting is best. The practitioner sits facing the patient on the injured side and places the patient’s hand on his or her own shoulder. The practitioner then gently massages the muscles around the patient’s shoulder while encouraging the patient to relax and allow the joint to reduce. As with any of the techniques described here, patient relaxation is the key.

Shoulder Reduction

General Principles

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The shoulder dislocation seen here can be difficult to distinguish from the AC separation seen on the previous page. The diagnosis can be confirmed by assessing the mobility of the shoulder joint.

Cunningham: • Patient sitting up straight, shoulders back, arm adducted, hand on practitioner’s shoulder, relaxed as possible. • Practitioner massages shoulder muscles until reduction occurs.

Treatment of Shoulder Dislocation

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Ischemia to infarction is an anticipated problem, as is increasing pain and disability. A shoulder dislocation from indirect force should be reduced in the field if the evacuation time to definitive care is greater than two hours, or if the evacuation will be difficult, dangerous, or unreasonably painful to perform. It is safe to say that these criteria are met by most backcountry and marine situations. There are many techniques that are effective in reducing dislocated shoulders. The best for field use are performed gently and slowly and there is low risk of causing further injury. The patient’s cooperation and relaxation are essential to the process. Three example techniques are described here. The Cunningham Technique The Cunningham technique and its variations takes advantage of the fact that the joint is most balanced and stable in its normal position and, given a chance, will sometimes return there on its own. The idea is to put the dislocated joint at rest,

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Simple External Rotation Simple external rotation can be used when the patient presents with the arm down with the elbow near the chest. Reduction is usually per- formed with the patient sitting up straight with shoulders back and relaxed.

Shoulder Reduction

General Principles

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Simple External Rotation: • Patient sitting or lying down. • Practitioner externally rotates humerus with slight traction. • Assistant or practitioner massages shoulder muscles.

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