Dislocated shoulder: what to do when the usual position hurts?

[Matthew99]

I'm asking this question because it happened to my friend a few days ago and I wasn't sure how to properly sling his arm. So this is the question:

If someone has a dislocated shoulder, and you dress him with a sling, but he tells you it really really hurts when his arm with the dislocated shoulder is close to his body (touching the abdomen) like this:

But it really DOESN'T 't hurt when the arm isn't close to his body:(when the shoulder is flexed and the arm is raised a bit) - kinda like this

Would you put the sling differently to make him comfortable or the same usual way as in the top pic despite his incredible pain in this position?

I wanted him to feel comfortable because he is my friend, so that's what I did an we just rushed him to the hospital like that. I wasn't sure if what I did was the right medical thing to do.

Edited August 15, 2011 by Matthew99

[scubanurse]

The second picture is probably the best way to sling a dislocated shoulder. That is what I know as the neutral position for the shoulder or the position of use. How often do we have our forearms lay flat against our bellies versus having our arms out a little and to the side? Even as I type this there is a little space in my armpit and my forearms are facing forward.

Think about how when a shoulder dislocates what happens. The humeral head in most cases will roll anteriorly and drop inferiorly a little bit. (I'm guessing your friend had an anterior dislocation so I won't go into inferior or posterior dislocations unless you want me to.) When you try to move the forearm across the abdomen and it is still dislocated, you are putting a tremendous amount of stress and pressure on that humeral head. By abducting (moving the humerus away from the body) the shoulder by about 15 degrees, you are relieving that pressure and more often than not easing the patients pain and reducing the muscle spasms.

After shoulder surgeries, depending on the type, you will see more and more often now people being placed in what is called an Ultra Sling which has that padding and holds the arm at a more natural position.

All in all when it comes to splinting, it's hard to do the wrong thing medically if your patient is more comfortable.

ETA: more info.

Edited August 15, 2011 by Kate_826

[Richard B the EMT]

Pillows as splints, or for filling voids, can be useful, even with "sling and swath" crevats.

[ERDoc]

Position of comfort, however you can do that. It'll be put back in once he's in the ER.

[Matthew99]

So I see now it would've been a mistake forcing him to a typical sling position. That clears it. Thanks for settings me straight.

[Chief1C]

We have a single piece, hinged splint for dislocations; but I'd suggest a nice fluffy pillow, folded if necessary. It almost appears as thought there is also a humerus fracture. I wouldn't be sitting there like that, I dislocated my shoulder when I was a kid. Passed out. Great thing to do when something really hurts, if it doesn't hurt that bad, looking at it usually helps complete the process of syncopy.

[scubanurse]

Position of comfort, however you can do that. It'll be put back in once he's in the ER.

If I had a nickel for every time an ER doc told me it would be a piece of cake and not to worry, I'd be a millionaire...

[ERDoc]

For a dislocated shoulder? With proper pain control and sedation, I've had a zero failure rate. Next time it happens to you, give me a call and I'll make sure it goes back in. It should be a piece of cake so don't worry.

[scubanurse]

LOL... not always the going in part that is the problem... when a doc has to stand there with their arm against the humeral head to keep it back...that's when we run into problems

[ERDoc]

Yeah, at that point you've probably torn the cartilage pretty bad and need to have surgery to fix it.