Today I'm with Dr Lucy and she's going teach me how to relocate a shoulder
because that's an injury that's quite common in our sports
and it can be actually quite useful to know how to deal with it.
So Lucy, we just did this amazing run
but at the bottom I hit a rock and my shoulder is so painful.
What do we do now?
So first of all, just make sure that the scene is safe
that you're not in any falling rocks
there's no avalanche,
make sure there's not other skiers and boarders coming past to upset you.
Find a place to sit them down
make sure that they're relaxed
and make sure that you're comfortable in this position to relocate it.
And then before you go straight to the shoulder,
just make sure you're not missing anything
so make sure you've done your primary survey
your airway, breathing, circulation,
they've watched your video
your how to first aid video!
check it out!
So that you've made sure that the casualty is otherwise okay
and it's just a shoulder injury.
Do you actually ride with the painkillers in your backpack?
Yeah I always ride with painkillers
and so, simple things like paracetamol, ibuprofen
if you've done a first aid course you might be able to have some penthrox,
which is fantastic
but that's on prescription and needs professional...
That is on prescription but if you've done a course you could be prescribed it for you,
for your expedition
but just make sure you always ask the casualty if they've got any allergies
and if they're happy to take the pain relief
and that's just check.
What you want to do is have a look and think, well is this a dislocated shoulder?
So you want to look at them
see they're probably going to be holding their shoulder in pain
if you can, you want to try and slide a hand just inside of the jacket
and if you slide it on the good side
you can feel that this shoulder has a nice rounded edge
and you can feel a sort of a divot of skin,
just where the shoulder meets the chest
if you come over to this side it'll be very tender
but as you slide your hand over the top of the shoulder
over the deltoid muscle
it'll feel very squared off
it'll feel like it kind of falls away
and you might even feel a lump
just in the front aspect here, of the chest,
where that humeral head of the shoulder has just moved forward
and dislocated.
If you ask the casualty to try and touch their other shoulder
they won't be able to do that.
So, just below your nice badge here
in fact it's called the auxiliary badge
you just want to say to them give a little rub
and say can you feel me touching you there ?
yeah!
Yup! that's good!
So you know their nerves intact
and then a few simple tests
just ask them to give you a thumbs up
they should be able to do that
ask them to cross their fingers
and then ask them to make a finger gun
and if they can do all those things their nerves are okay.
Okay good
Okay and if the nerve is not okay do you still do the..
You should still try and relocate it
but just make sure that you write down or document somewhere
that they couldn't do or they couldn't feel it or they couldn't do those moves
Okay.
so that they know, that when they get to hospital,
they know it was damaged in the injury.
When you come to relocate the shoulder
again just make sure the casualty is comfortable
you've given them some pain relief
their jacket's done up
they're nice and warm
and just explain what you're going to do
and that once it's back in they're going to feel a lot more comfortable.
okay
so then all you're going to do
is take the arm,
this bit takes quite a long time
and you're going to be really gentle
with the heel of your left hand
you're just going to hold the elbow in at their side
and then really really gently
really gently
you're going to start moving their arm,
right out to the side.
Now they're going to get spasms of pain during this
so at some point, they're going to stop you moving them
and you're going to feel a lot of resistance
you could give them a little shoulder massage
just to help relax those muscles
oh and then when you feel that spasm of pain is gone
and you feel the muscles relax
keep the elbow in at the side
and move it just very gently.
Now this whole process to get right out as far as here
could take you anything up to about like 15 minutes or so
just really slow, really gentle,
just talking to them, reassuring them,
keeping them calm.
Once you're out this far
you'll feel a bit of resistance
and you might even feel just a little bit of a click
or something as your humeral head is engaging in your shoulder joint
so at that moment,
as you've gone out as far as you can
as wide as you can
in one quick movement
you're going to bring the arm across the body
and to touch the opposite shoulder
and at that moment you'll feel this really reassuring clunk
as the shoulder goes back in.
So I will feel or will you feel it?
We'll both feel it
okay aright
we'll both feel it.
All right, you can just put that around there
and just slide it in
yeah
oh great
and that's pretty easy.
um if you don't have a sling
you can just use the harness in a similar way
just through threading it
just put one loop through this arm
or over their shoulder
and then putting that in there
getting them to relax in there
yeah and then again just tying it off
at the back
yeah one way or another
exactly
even like this yeah
oh yeah that feels actually quite tight
I'm just gonna wrap that in
and it keeps it warm, it's great.
Keeps you warm, just tuck it in.
And then if you want to you could just check again
to say you know can you still feel me touching you here?
Just to make sure you haven't trapped any nerves when you're relocating it.
All right, and at this at this stage
it might be a lot easier to
go back to civilization if i need to
if the rescue cannot make it
or if not we're gonna be waiting for rescue right?
Yeah you'll be a lot more comfortable so while you're waiting
keep them warm
keep topped up with the pain killers
and maybe just check at that stage
just check that they don't have any other injuries
or anything else that you've missed perhaps.
If you are really stuck
and the emergency service is going to take a long time
and you have to get out
and the other method didn't work
you could try this one once
it just requires quite a lot more force
and can be slightly more uncomfortable for your casualty
if it's just you and you don't have anyone else to apply counter-traction
you get them propped up against a rock or something
a little bit harder in ski boots
or against me?
or against you - but you need to be leaning back on something
and then you get your foot into their armpit
and you apply loads of traction
you pull, pull, pull, pull, pull
getting your toe right up in their armpit
and then a slight, you're turning their palm up towards the sky
and moving their arm out very gently to the side
and hopefully with that
about 30 degrees
okay
and hopefully with that you should just hear it pop back in.
But it's it requires quite a lot more force
that mechanism and is a bit more uncomfortable.
So what kind of mistake could I be doing?
If I do something wrong, like what could I do wrong?
It's difficult, I think the biggest thing would be to know if it's a fracture or a dislocation
okay
and sometimes if you're in the outback you're not gonna know that
but if you try and put it back and it doesn't work
then just put it in a sling, leave it, it might be that there's a fracture instead.
The other big risk could be that you might fracture it whilst trying to put it back
but again if you do the techniques that I've shown you
that's rare, and
again if you if you're in the outback and you need to get out
you need to get that shoulder back in.
Okay.
So all the complications are rare but just explain them to the casualty before you put it back
and just say, you know "you're happy for me still to have a go at doing this?"
and we need to get out of here anyway so we have to give this a try.
Cool, one more question.
If I'm close to a ski resort
or if I know that the rescue is going to come because I've talked to them
I know they're on their way
is it worth to just leave the victim like this?
Or is it good for me to try anyways?
Yeah I think so that'll depend
if the rescue services are really close by
and you've not done this a lot
just wait for the rescue services
it might be that your casualty does this to their shoulder regularly
and that they're happy for you just to help pop it back in.
So every situation is different, but so long as you explain your level of expertise
and know how close the rescue services are
then you can make that judgment call
but every situation is different.
Dr. lucy thank you this is really valuable information
it's the kind of thing which you learn sometimes
but which you need to work on all the time
and I think in the backcountry it's always really important to be self-sustainable
the more self-sustainable as a team you are
the more you're gonna have a reach within your adventures.
So thanks for all this medical information,
this is gold, give us some more because we love it!
All right be safe out there.