Page 187 - PJ MED OPS Handbook 8th Ed

Shoulder Dislocations
1. In general, the patient will not move their upper extremity and a step off at the shoulder joint is
usually visible and/or palpable.
2. Provide procedural sedation unless present when it happens since spasm may take time to de-
velop. Midazolam acts as a muscle relaxant. Be patient for decreased spasm.
3. By massaging the shoulder to relax the deltoid, and gently abducting (moving the arm off the
body) to 90°, and externally rotating the shoulder the humeral head should relocate.
4. Scapular manipulation is an alternate method.
5. Sling and swathe the upper extremity after relocation.
6. Note that is important to palpate the shaft of the humerus and rule out step off or point ten-
derness. If there is a suspicion of fracture (more common in the elderly or high speed vehicular
trauma) do not relocate the shoulder, sling and swathe only.

Appearance of Dislocated Shoulder

Scapular Manipulation Reduction Method
Have the patient sit upright or lay face
down. If sitting, support the affected arm
straight out from the body. If lying prone
on a table allow the arm to dangle straight
down. Apply 5–10 pounds of long-axis
traction to the arm. Stand behind the pa-
tient, grasp the tip (inferior portion) of the
scapula and rotate it inward (towards the
spine) and superior (towards the head)
with a slow, gentle and continuous motion.

Chapter 13. Packaging and Splinting n 185