When it comes to dislocation of the shoulder, rapid treatment is best to eliminate the stretch and compression of nerves and muscles in the area; it also reduces the muscle spasm which can make getting the shoulder back in to the correct position more of a challenge if left for greater lengths of time. Not least, early treatment resolves the not insignificant problem of unnecessary pain that the patient suffers.
In the hospital setting the patient is usually lightly anaesthetised and/or given a muscle relaxant. These medications are very powerful and therefore the patient will need constant monitoring in the resuscitation or high dependency area during treatment. As a student nurse and again while I worked in the Emergency Department as a staff nurse, I was occasional witness to what looked like tortuous efforts on the part of doctors to reduce (put back) dislocated shoulders. These eye watering procedures usually involved a lot of pulling while some doctor’s be-socked foot would be pushed in to the armpit region as a sort of counter-traction as they pulled the arm. Numerous methods to achieve the desired end exist, often deservedly named after the clever doctor who had spent long hours devising it.
Beautifully depicted here showing what appears to be a random child providing counter-traction is the Hippocrates Technique!
Despite the numerous methods, all with their relative merits, sadly, little has been written about or developed for application in the pre-hospital arena. This means that as paramedics we simply give the patient analgesia, stabilise the affected arm and convey to hospital navigating bumpy highways and byways en route which only add to the discomfort.
Luckily for me, during my placement in the ED for my Emergency Care Practitioner training, a kind and helpful registrar taught me a wonderfully easy technique to reduce a simple dislocation of the shoulder (by that I mean those dislocations where there is no suspicion of a fracture) and now I am pleased to say that so far 6 patients have benefited from the technique – all of whom have been very grateful! The Stimson’s Technique doesn’t involve any torture and is relatively stress free. Personally, I’ve found that it has never taken more than 5 minutes for the shoulder to ‘pop’ back to where it should be. If I can get them to really relax or even better, have a laugh about something, it seems to help speed up the process. I’ve performed it on a pub table, the back of a sofa (x2) and a canteen table amongst other places! (Telling them just that often makes them laugh funnily enough!).
However, with one of my patients, the process seemed to be taking longer than expected; I rubbed and manipulated the joint for an age and still no ‘pop’. Finally, admitting failure, I said to him that I would have to refer him to a medical colleague for further treatment and he said.
‘Oh no, it’s ok, it went back in ages ago’
‘Really? Why didn’t you tell me?’ I asked
‘The massage felt nice’ was his cheeky reply!
Another success story at least – even if he was a bit naughty!
These patients will still require good analgesia and a trip to hospital for a follow up x-ray but the ‘time to treatment’ is vastly reduced – which has to be a good thing for the patient. I would love to see it brought in routinely for pre-hospital use so more patients can benefit.