In this video, we’ll dive into one of the most prevalent wilderness medicine concerns: shoulder dislocations. As an experienced guide or adventurer, it’s likely that you’ll encounter this issue at some point. We’ll focus on anterior shoulder dislocations, which are the most common type in the wilderness.
To begin, let’s learn how to recognize a shoulder dislocation. One way is to ask the patient to touch their opposite shoulder. If they can’t do this, it’s a strong indication of a dislocation. Another clue is to observe the patient’s overall anatomy. Compare the affected shoulder to the uninjured one. On the dislocated side, you’ll notice a concavity where the humeral head (the ball of the shoulder joint) should be located. This is because the humeral head has slipped out of its normal position.
Understanding the anatomy of the shoulder joint is crucial for managing a dislocation effectively. The humerus (upper arm bone) has a rounded head that fits into a shallow socket on the shoulder blade (glenoid cavity). When the humeral head is dislocated, it can become trapped beneath the acromion process (a bony projection on the shoulder blade).
To reduce the dislocation, we’ll use a technique called the Milch maneuver. This involves pulling the arm straight down, applying upward pressure on the humeral head, and then rotating the arm back into place. It’s important to note that this maneuver can be painful, so it’s essential to ensure the patient is comfortable and prepared. With proper execution, the Milch maneuver can effectively reduce most anterior shoulder dislocations.