A nice day at work
Posted by GruntDoc on September 18th, 2007
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.
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September 18th, 2007 at 8:50 am
Didn’t do anything? Whatever. You taught him how to fix himself.
I bet he didn’t even ask for narcotics :-)
[GruntDoc: no, he didn't.]
September 18th, 2007 at 9:19 am
I think you did a lot! Instead of giving a man a fish to feed him for a day you gave him a fishing pole so he could feed himself for the rest of his life. Or at least until he knocks his hip out of the socket.
September 18th, 2007 at 9:20 am
Didn’t do anything? You taught a man to fish!
September 18th, 2007 at 11:00 am
Yup, a friend did that once. Hopefully, though, he won’t have to do it again. People can try that but it would be better if they’d be in the hospital while they’re at it. Just so, you know, if anything goes wrong…
September 18th, 2007 at 11:49 am
So did you bill for the reduction?
[GruntDoc: No, I did not, and told him that if he did get a bill for one to write me and I'd turn it off. I don't know how to bill for self-help, and don't want to know.]
September 18th, 2007 at 10:38 pm
That’s a new one to me, pretty cool. I work with a doc that is very skilled in getting the patient to relax while talking quietly to them and then will pretend that he is just examining the arm, move it around slowly and very gently then, ta dah, it slips right back almost painlessly. Relaxation is the key.
September 19th, 2007 at 7:36 am
Another technique is to have the patient sit in a swivel stool, grab a pole with the affected hand, and slowly rotate his body away from the pole so that the arm undergoes external rotation.
September 21st, 2007 at 1:55 pm
So, how common are dislocations? What are the primary causes? And
can I still go blindare there certain circumstances one should avoid to lessen ones chances of dislocation?September 24th, 2007 at 9:47 pm
I’m a new reader of your blog…and this has nothing to do with the post but I’m glad to see you’re a fellow Red Raider!