A Twist of Fate

Shoulders are scary dislocations because the injured person suffers great pain, usually worse than that of a broken bone. Unnerving as it is to have a climbing buddy screaming in agony, it is important that you keep your wits about you so you can help.

The structure that gives the shoulder joint its impressive range of motion is the same that allows it to dislocate easily. This is the small glenoid socket, a shallow concave surface on the outer edge of the shoulder blade. The humerus, the long bone of the upper arm, fits into this and rotates around inside it. Good for range of motion. Bad for stability.

The most common type of dislocation occurs when the upper arm is lifted sideways and then pulled backwards. This can occur from a fall onto an outstretched hand or stretching into a crucifix position on the rock. It could also happen if you drop onto an arm after your foothold gives way or if you barn-door out of balance while stemming or using your arm in a crack.

A person with a dislocated shoulder will frequently hunch over, gripping his forearm and holding the entire arm away from his body. This is an instinctive attempt to stabilize the joint. The normal rounded contour of the shoulder will appear scooped out. He may have numbness and tingling in his hands and fingers and on the skin overlying his shoulder.

When dealing with a person whose shoulder is dislocated, remember that everything he does—including walking, moving in any way, even breathing—causes pain. Part of your job will be calming and reassuring him so he will let you immobilize the shoulder and ease his pain.

The victim will be reluctant to put his arm down at his side and bend his elbow. But, with patience and reassurance, you should be able to bend his elbow if it is not involved in the injury. Then gently bring the upper arm as close as possible to the side of his chest, and generously pad the space between the two with a rolled parka, sleeping bag, or tent. Now put the victim's arm in an improvised sling; if he-is wearing a button-up shirt, have him put his arm through it, Napoleon-style. Finally, wrap the victim's slung arm to his body using a swath made from spare clothing. If the shoulder is properly immobilized, the victim's pain will diminish and he should be able to walk out to seek medical care. Once again, try to reduce swelling by applying ice or a cool compress for 20 minutes every hour.