Protocol 5: Joint Dislocation Reduction

This protocol specifically applies to dislocation reduction of the anterior shoulder, lateral patella, and phalangal 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

Any manipulative technique that is performed slowly and gently on an awake and cooperative patient is generally safe. For the purposes of this protocol the Cunningham and Stimpson reduction methods are described. These techniques can be used in sequence or in combination as needed to achieve a successful reduction. Discontinue the procedure if pain significantly increases and/or if physical resistance is encountered. Neurovascular status (CSM; circulation, sensation, movement) is documented before and after reduction. Non-emergent medical evaluation is advised but may be delayed by up to 10 days if distal circulation and sensation has returned to normal.

 

Cunningham:
This technique encourages muscle relaxation which may allow the humeral head to return to normal position without additional manipulation. The patient is positioned sitting upright with the shoulders back and chest out facing the practitioner. The patients arm remains adducted (against the body) while the hand placed on the practitioner’s shoulder (right dislocation, right hand on practitioner’s left shoulder). The practitioner massages the trapezius, deltoid, and biceps muscles until reduction is achieved.

 

Stimpson Reduction Method:
Have the patient lie either face-down with the affected arm hanging down over a ledge. Secure approximately 10-15 lbs of weight to the patient’s arm; attaching around the upper arm or wrist, and allow the weight and gravity to fatigue the muscles until the shoulder is reduced.

Lateral Patella Dislocation

1.
Check and document distal neurovascular function (CSM; circulation, sensation, movement).
2.
Gently straighten the patient’s knee and flex the hip. If the patella has not spontaneously reduced once the knee is fully extended, gently guide the displaced patella medially back into its normal anatomic position. Discontinue the procedure if pain significantly increases and/or if physical resistance is encountered.
3.
Stabilize the patella with tape or an elastic wrap.
4.
Reassess and document distal neurovascular status (CSM).
5.
Arrange for non-emergent medical evacuation to definitive care for further evaluation. Patient may walk out if pain is tolerable.

Digit Dislocations (Fingers, Toes)

1.
Check and document the distal neurovascular function (CSM; circulation, sensation, movement) of effected finger or toe.
2.
Apply axial traction distal and counter-traction proximal to the dislocated joint until the dislocation has been reduced. Discontinue the procedure if pain significantly increases and/or if physical resistance is encountered.
3.
Splint in the anatomical position.
4.
Reassess and document distal neurovascular status (CSM).
5.
Arrange for non-emergent medical evacuation to definitive care for further evaluation.

 

The Joint Dislocations Protocol has been authorized for use by Center for Wilderness Safety certified WEMT, WFR, WAFA, and WFA (including WFA Afloat) trained members of the organization providing authorization and oversight of the provider.

 


Last Updated: Nov. 2019

Divider

These protocols were written by Jeffrey Isaac, PA-C (of Wilderness Medical Associates International) and have been edited and authorized by the executive medical and curriculum directors Kathryn Vaughn, MD, FAWM & Jennifer Kay, RN, BNS, CCRC, CCRP, WALS, for use by Center for Wilderness Safety, Inc.



AVAILABLE DECEMBER 2019


Want to Sponsor a Wilderness Medicine Course @ Your Location?LEARN MORE
+