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.


Comments

  1. 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.]

  2. 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.

  3. Aerospace Genius says:

    Didn’t do anything? You taught a man to fish!

  4. 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…

  5. 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.]

  6. 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.

  7. erscutmonkey says:

    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.

  8. Jim in Texas says:

    So, how common are dislocations? What are the primary causes? And can I still go blind are there certain circumstances one should avoid to lessen ones chances of dislocation?

  9. 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!