A Twist of Fate

Assess and stabilize the injury—then vomit when your elbow bends the wrong way

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Scrambling down the descent gully after a long day of climbing, you slip and twist your knee. When you pull up your pant leg, you almost puke—a sickly looking lump sits a couple of inches to the outside of where your kneecap used to be, and it feels like someone shoved it there with a bulldozer. Welcome to the world of dislocations.

Climbers have a high risk of dislocating their joints. Stumble off—or on—the beaten track and it's easy to blow out a knee. Lunge for an ambitious hold or take a nasty fall, and you could throw a finger, toe, or shoulder out of whack. All of these dislocations hurt like hell. Worse, those of the shoulder and knee can severely impede your mobility, and are likely to happen a long way from medical care.

If you or your climbing partner suffer a dislocation in the backcountry, you will have to assess and stabilize the injury before you can return to civilization.

Joints and dislocations

Joints are the junctions of two bones. They are held together by ligaments and spanned by tendons, which are attached to one bone directly and the other by way of its muscle. When the muscle contracts, it pulls on the tendon, causing the joint to bend or rotate.

In normal use the bone ends in a joint fit tightly together and move about each other smoothly, like cogs in a set of gears. But a wrenching pull or impact on a joint, like ramming your car into the wrong gear while speeding down the interstate, can overcome the protection offered by ligaments and tendons and cause a dislocation. Now the bone ends grind against each other when you try to move, causing pain. Rapid swelling, as our body attempts to form its own splint and immobilize the joint, compounds the disability.