Treating Fractures in the Field

Lesson 5: Fractures of the Upper Extremities

5-7

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5-7. IMMOBILIZE A DISLOCATED SHOULDER

A dislocation of the shoulder occurs when the head of the humerus is pushed out of its socket at the shoulder. The dislocation can be either anterior (the head pushed forward) or posterior (the head pushed backward). Most dislocations will be anterior dislocations. Shoulder dislocations are painful and the casualty (if conscious) will usually attempt to hold the arm on the injured arm to prevent movement. The shoulder will not have its normal rounded appearance. Immobilize the injured shoulder and upper arm without attempting to reduce the injury (replace the humerus in its socket).

a. Anterior Dislocation. If the head of the humerus is displaced toward the casualty's front, the arm will be a fixed position away from the casualty's chest. Do not try to reposition the arm as any attempt to move the arm toward the chest will produce additional pain. Immobilize the arm in the extended position.

(1) Check the casualty's pulse below the dislocation. If no pulse is found, evacuate the casualty as soon as possible after the arm is immobilized.

 

(2) Apply padding (a rolled blanket, pillow, or other material) between the upper and the chest to fill the space between them.

 

(3) Flex the elbow so the casualty's wrist is slightly higher than the elbow.

 

(4) Apply a sling (arm sling number two) to support the forearm.

 

(5) Apply a swathe to further immobilize the arm and to secure the padding materials.

 

(6) Evacuate the casualty in either a sitting position or laying on a litter.

b. Posterior Dislocation. If the head of the humerus is displaced toward the casualty's back:

(1) Check the casualty's pulse below the dislocation. If no pulse is found, evacuate the casualty as soon as possible after the arm is immobilized.

 

(2) Position the casualty's forearm across his midsection with his wrist slightly higher than his elbow.

 

(3) Apply a sling to immobilize the arm. Use the arm sling number two method to protect the shoulder from additional pressure.

 

(4) Apply a swathe to further immobilize the arm.

 

(5) Evacuate the casualty, either in sitting position or lying on a litter.

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