Archives for September 18, 2007

A nice day at work

I had a nice day at work. So did at least one of my patients.

We were busy, and the patient had his third anterior shoulder dislocation in about 18 months. Nice square shoulder of dislocation, normal sensation over the deltoid and distal neurovascular function, nothing terrible or unexpected. Essentially he just wanted / needed it reduced after an atraumatic dislocation.

I asked if he’d ever tried any of the reduce-it-yourself maneuvers for shoulder dislocation, and he asked ‘do you mean the one where I lie on the edge of a bed with a weight in my hand?’, telling me he really had been through some relocations before.

I briefly explained a very straightforward method (this is not medical advice: if you dislocate your shoulder, go to the ED, and that is medical advice) wherein the patient laces their fingers, flexes the hip and knee, and then places the laced fingers in front of the knee. Then, relaxation is the key, as the patient gently leans back / lets the leg go forward, and tries to relax. The idea is to have the scapula rotate forward (opening the glenoid fossa and gently pulling the humeral head into alignment) aiming for the clunk of happiness.

I got busy seeing other patients and got a call about 10 minutes later “…the patient thinks their shoulder is back in”. It was! To say the patient was happy would be an understatement. A quick x-ray showed normal alignment, and home went a patient with a new skill.

It’s the happiest I’ve been in a while, and I didn’t do anything.