A Twist of Fate

You hobbled off the mountain.
What next?

Professional Treatment
After any dislocation, go immediately to the emergency room. The sooner the dislocation is reduced (returned to its normal position), the easier the procedure is to perform and the faster your recovery should be. The reductions of fingers, toes, and patellae are usually fairly simple, non-surgical procedures. The reduction of a shoulder can range from a quick manipulation to a significant tug-of-war requiring intravenous sedation and pain medication. Surgery is occasionally required.

Rehabilitation
There is a fine line during rehabilitation between insufficient use and overuse of the injured joint. With too little activity, the joint stiffens; with too much, it can be re-injured. To determine this fine line, talk with your health-care provider and tell her the type of activities you participate in. Better yet, try to find a kindred spirit in the health-care profession—maybe a doctor or physical therapist—who is also a climber and can put you on the best exercise and recovery program for an athletic person.

Recurrence of Dislocations
Once you have dislocated a joint, it is more likely to happen again. The joint's supporting and stabilizing structures, especially the ligaments, are now more lax than before the injury. Once your health professional gives the green light, you can reduce your chance of another dislocation by doing exercises to strengthen the muscles surrounding the joint. While they do not replace the function of ligaments, strong muscles can increase joint stability and reduce the potential for re-injury.

Shoulder dislocations are the most likely to reoccur, and surgery is a last resort for those who suffer them frequently. Traditionally, this has involved cutting into the muscles and supporting structures and shortening the ligaments. Unfortunately, rehabilitation takes up to one year and pre-injury flexibility and strength are almost never fully restored. Some hope, however, may lie in an alternative surgery that shrinks the supporting structures with a special electrothermal probe. This procedure has recently been approved by the FDA, and although the long-term benefits of it are not yet known, early results have been encouraging.

The Bottom Line

If you spend time in the backcountry, there is a good chance that you will have to deal with a dislocation at some point in your climbing career. The better prepared you are to handle this and a wide variety of other wilderness medical emergencies, the better off you will be.

The brief overview presented in this article is not intended as a substitute for medical training. Luckily, you can take an on-going series of wilderness medicine courses. These provide skills and knowledge that are as important as your ropes, slings, harnesses, and carabiners. Think of medical training as an essential"piece of gear" for your next backcountry climb.