Protocol 5: Dislocation Reduction

This protocol specifically applies to dislocation reduction of the anterior shoulder, lateral patella, and digits resulting from an indirect force; all other potential dislocations should be treated as one would treat any other potentially unstable joint injury (i.e. splint in a position that maintains stability and neurovascular function while facilitating transport). For all other areas of the body, dislocation reduction is not recommended, and is not covered under this wilderness medical protocol.

A history confirming that there has been no direct injury to the affected joint and an examination with findings consistent with a dislocation must be obtained prior to treatment. The following procedures should be stopped if pain increases and/or resistance are encountered.
 

Anterior Shoulder Dislocation (Reduction)

1.
Check and document finger motion and sensation over the fingers and deltoid region of the affected side.
2.
With the patient in the supine position, and while sitting adjacent to the dislocated shoulder, apply gentle traction to the arm to overcome muscle spasm. Gradually abduct and externally rotate the arm until it is at a 90-degree angle toward the patient’s body. This is most easily achieved by keeping the elbow in the 90 degrees of flexion throughout the maneuver. Hold the arm in this position (“baseball throwing position”) and maintain traction until the dislocation has been reduced.
3.
An alternative method of reduction takes advantage of gravity. Ten pounds is secured to the patient’s arm while she is lying face down with her arm hanging unsupported. This process can be facilitated if the rescuer stabilizes the upper portion of the scapula with one hand while rotating the lower tip medially with the other. Reassess and treat in the same fashion after the reduction is complete.
4.
Once either the dislocation is reduced or the rescuer decides to discontinue reduction attempts, adduct the humerus so that the elbow is alongside the body. Then internally rotate the arm across the body and sling and swathe.
5.
Reassess and document distal neurovascular status.
6.
Transport patient to hospital.


Lateral Patella Dislocation (Reduction)

1.
Check and document CSM (circulation, sensation, movement) of foot and toe.
2.
Gently straighten the patient’s knee and flex the hip. If the patella does not spontaneously reduce, gently guide the displaced patella medially back into its normal anatomic position.
3.
Splint the knee in a neutral position (10-15 degrees of flexion).
4.
Reassess and document distal neurovascular status (CSM).
5.
Transport patient to hospital. Patient may walk out if pain is tolerable.


Digit Dislocation (Reduction): Fingers and toes (not including thumb)

1.
Check CSM (circulation, sensation, movement) of effected finger or toe.
2.
Stabilize the hand and gently pull in the direction of the distal finger until the dislocation has been reduced.
3.
Splint in the anatomical position.
4.
Reassess and document distal neurovascular status (CSM).
5.
Transport patient to hospital.

 

These protocols were written by Jeffrey Isaac, PA-C (of Wilderness Medical Associates International) and have been edited and authorized by Kathryn Vaughn, MD & Clifton Castleman, WEMT, for use by Center for Wilderness Safety.



Download the CWS Wilderness Medical Protocols

 

 
 

– PROTOCOLS –

   •  - Overview
   1 - CPR
   2 - Asthma
   3 - Spine Clearance
   4 - Wound Closure
   5 - Dislocations
   6 - Anaphylaxis