# Dislocated shoulder options



## flhtci01 (Jul 27, 2008)

Has anyone used a vacuum splint to immobilize a dislocated shoulder that could not be reduced?  Pros and cons? I am looking for possible options that involve the cold, outdoors and ease of use.  Any other suggestions are welcome.

Thanks


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## Ridryder911 (Jul 27, 2008)

For dislocations, nothing beats the old sling & swathe method. Again, dependent upon ant or post dislocations. 

R/r 911


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## MMiz (Jul 27, 2008)

Would a vacuum splint really be worth the added cost, maintenance, and required storage space?  Do you have extraordinarily long transport times?

I've never seen them used in EMS, though I'm sure you'll find someone who has.


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## flhtci01 (Jul 27, 2008)

Ridryder911 said:


> For dislocations, nothing beats the old sling & swathe method. Again, dependent upon ant or post dislocations.
> 
> R/r 911



I agree but if it cannot be reduced to a position that a sling and swathe is useful, what do you do?

I am looking at stabilization for transport over some rough terrain.


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## akflightmedic (Jul 27, 2008)

Click on the link for entire story and pictures...

This is a great article promoting evidence based medicine, as we have used sling and swath for thousands of years and it may be doing more harm than good.



http://www.mja.com.au/public/issues/179_07_061003/mur10335_fm.html


Treatment of shoulder dislocation: is a sling appropriate?

George A C Murrell 
MJA 2003; 179 (7): 370-371
Introduction
 — Competing interests
 — References
 — Author details

Abstract
Acute anterior shoulder dislocations, when managed non-operatively, have traditionally been treated by placing the arm in a sling. There is no formal evidence that this treatment is of benefit.

Three recently reported studies, one in cadavers and two in patients, suggest that the detachment of the structures in the front of the shoulder is made worse when the shoulder is placed in internal rotation, as when the arm is in a sling. By contrast, the structures are realigned when the arm is placed in external rotation.

Shoulder dislocations, if managed non-operatively, should not be treated by placing arms in a sling. Rather, placing them in a splint or using a pillow so that the the arm is externally rotated should be considered.

For thousands of years, perhaps even before Hippocrates, dislocated shoulders have been treated by using a sling with the arm internally rotated. Although, and perhaps because, this same treatment has been used for so long, there is little information on its efficacy. A number of studies of non-operative treatment for anterior shoulder instability have been unable to show that any given treatment is better than another, and all have been unable to reduce the rate of recurrence.1 Surgery has provided better outcomes in terms of preventing recurrence of shoulder dislocations,2 and even for symptoms of instability. A recent randomised clinical trial involving 40 patients and comparing sling immobilisation with arthroscopic surgery in first-time shoulder dislocation showed a recurrence rate in the surgical group of 16% at 2 years versus 47% in the sling group.3 Patients in the sling group whose shoulders had not redislocated also had worse functional scores than those in the surgical group. In particular, they were less able to participate, and performed at lower levels of sport and recreational activities than patients in the surgical group.


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## reaper (Jul 27, 2008)

I have had good results with padding under the arm and swathing to the body. But not in a sling. Let the arm hang down, if able. Secure to body to minimize movement.


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## Tiberius (Jul 28, 2008)

I agree with the tried and true pillow and swathe method.


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## mycrofft (Jul 28, 2008)

*Generically, immobilize in position of comfort if it has good circ and fits into the*

ambulance.

I've used air splints but not for a shoulder. Sling and swath but with a padding filler to position it properly usually worked ok on shoulders. Once, the shoulder was really dislocated anteriorly, I used an alumisplint to form a triangle and abduct the humerus and rotate it to the position of comfort, and then mediripped it into place without constricting the patient to death. This helped the pt until the squad lay him down on their ambulance litter which caused more pain. They removed my work and returned my splint, and propped him "comfortably" with little pillows.


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## MSDeltaFlt (Jul 28, 2008)

Ridryder911 said:


> For dislocations, nothing beats the old sling & swathe method. Again, dependent upon ant or post dislocations.
> 
> R/r 911



True.  Low tech is the best tech.


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## fma08 (Jul 28, 2008)

Pillow and swath for me. Simple and effective.


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## flhtci01 (Jul 28, 2008)

We use the sling and swathe with pillow padding when the dislocation can be reduced that far.  _What do you do when it can't be reduced that far?_  Throwing them in a rig is not an option.  We have to transport them up to a mile over rough terrain to the rig.


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## mikeylikesit (Jul 28, 2008)

Pop that sucker back into place. Just pull mild traction after giving them a pain killer and PULL! then let it slide back into place....easy.


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## Jon (Jul 28, 2008)

SAM Splints has a book they'll give you with "all the ways to use the SAM Splint"

One solution is to make a triangle out of a SAM Splint, then use that to brace the arm out in a position of relative comfort.


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## BossyCow (Jul 28, 2008)

mikeylikesit said:


> Pop that sucker back into place. Just pull mild traction after giving them a pain killer and PULL! then let it slide back into place....easy.



Uh-huh.. and that's in your protocols????


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## Airwaygoddess (Jul 28, 2008)

I have never used an air splint for a dislocated shoulder, splinting and padding has worked very well for me.


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## rescuepoppy (Aug 14, 2008)

*Go for comfort*

Speaking from personal experience the best thing we can do in the field is try to get the patient in a position of most comfort. In doing this we will reduce the chance of further injury and make for a more relaxed patient. Usually this is best done using a swath either with or with out a sling, I am going to go with what my patient tells me is better for them.  In answer to the suggestion of reducing I am not going to try to manipulate the shoulder unless it is adrastic situation,(circulationor motor function compromised and a long transport time). However I will try to talk you into setting my shoulder when it is out, this can usually be done on me without analgesics,but that is just me. Dont recomend trying that with every one. 
   By the way I am glad to be back after an accident I was in followed by a couple of surgeries.


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## BossyCow (Aug 14, 2008)

Judging by your picture, are you looking at putting the pt in a stokes and hauling them out? How long is your pack out time to an ambulance? The angulation of the limb is going to determine how you stabilize it. 

But the major consideration is going to be padding. I'm not sure if the vacu splint will work in that venue. Once deflated they are hard as rocks and if you are going to immobilize the shoulder, the size needed may interfere with your ability to fasten the pt into a stokes.


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## emt19723 (Aug 14, 2008)

sling and swathe here too!!


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## flhtci01 (Aug 15, 2008)

BossyCow said:


> Judging by your picture, are you looking at putting the pt in a stokes and hauling them out? How long is your pack out time to an ambulance? The angulation of the limb is going to determine how you stabilize it.
> 
> But the major consideration is going to be padding. I'm not sure if the vacu splint will work in that venue. Once deflated they are hard as rocks and if you are going to immobilize the shoulder, the size needed may interfere with your ability to fasten the pt into a stokes.



Not transporting is a stokes, but similar configuration.  Transport time to a rig is close to an hour, then at least another 45 minutes on bumpy, winding backroads to an ER.  (Services are Basic, therefore no meds allowed). We have used various methods of immobilization including pillows for padding with a sling and swathe.  When I am working out of the rig we have used full body vac splints for immobilization.  But in the outdoor environment we don't have the space allowance for a full body vacuum splint.   

I know the vacuum splint get hard as rock but how is the support if the arm is abducted 90 degrees or more from the body? (And yes I have had them.)


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