As I held Tims' arm and gently pulled it came easily towards me. I could feel the head of his humerus slide across into the socket created by his clavicle and scapula. I released my grip; his shoulder seemed to spit the arm out of the socket as his muscle spasmed again. Tim's face whitened yet again.
Half an hour earlier our group of eight had been on the bank checking out the line down Rooster Tail, a class IV+ rapid in the Rangitata Gorge. Rooster Tail is at its safest at 140 cumecs, when the slot at the bottom flushes well to the right. It was Tim's first time down, and he had been paddling well. He watched the first few, and was on line as he headed towards the horizon. Slowed by the first wave he was tail stood by the second, and he reached out to stabilise himself as if completing a whoopie as the solid water at the back of the wave squirted him skywards. He continued to reach down and sideways for the water and doing so straightened his left arm as the boat fell over on that side. From my position on the bank it looked as if he tucked into a roll as the RPM went over.
As his paddle floated free I cursed him for once again relying on his hand roll, which he says [is] quicker and easier. Sure enough the hand roll came but somehow without its usual precislon, his right arm reached for the sky, he lifted his head and his left arm trailed in the water. As he washed past Pigs Trough and exited his boat the smirk was wiped from my face as his boat drifted away and he made little effort to swim. The others focused on gathering up his gear until Mike started yelling for someone to get Tim. Tim was pulled-into the last eddy above The Pinch - if he had missed this he would have swum around 1km of IV+ rapids. I had decided that this attempt to relocate Tim's left shoulder would be the last. I was increasingly concerned that I was doing more harm than good.
Tim was in great pain, and it now looked like he would have to walk out after all with his shoulder still dislocated. Mike found that Tim was most comfortable with his hand up at shoulder height like he was giving a stop signal, so he placed a paddle across Tim's shoulders and Tim held the shaft with his left hand to take the weight off the dislocated shoulder. Eugene, Mike and I would assist Tim while the rest of the group paddled out to get the shuttle sorted, to make it quicker to get him back to Christchurch.
We weighed up our options. We had tried to sling and stabilise his arm with duct tape, but when he stood and tried to walk the searing pain almost caused him to black out. It was two hours walk back to the cars, and while there was a 4WD track above us we where unsure where it lead to. Though Tim was comfortable with his arm supported by the paddle there was no way he could scramble through the surrounding scrub with it across his shoulders.
Even with forty five combined years paddling experience between us Mike and I were stumped. We had only seen one or two dislocations each and those times the people had fixed themselves. Eugene said he wished we had a first aid book or something, and then I remembered that hidden in my rescue bag was a set of safety flash cards. I dug them out. Sure enough there on the cards was a easy to follow explanation of how to relocate a shoulder. We decided to try again.
We explained to Tim what we would be doing, and obtained his consent. Using the method on the cards his shoulder slipped back into position easily and we duct-taped his arm to his body for support. He had immediate relief from the pain and after five minutes or so decided he was able to walk out. Eugene accompanied Tim while Mike and I towed their boats down the river. They climbed in and out of gullies, over deer fences and through thickets of matagouri for the next 2 hours to reach the cars.
Once back in Christchurch Tim went to A&E for a check up and x-ray, within a couple of weeks he was back paddling on flat water and now reports that he has full use again; though he knows that future dislocations may occur more easily in this shoulder.
Ouring discussion after this incident a few things have come to light:
- Prompt reduction of dislocations speeds recovery, however full rehabilitation takes months and is best done in consultation with a doctor or physio.
- There are a range of methods for relocating shoulders and if we intend to paddle in areas without easy and quick access to medical help we should get training in at least one of them.
- It is important to get the patient's consent before attempting to reduce a dislocated shoulder after informing them of the limits of your knowledge and of the possible damage that could be caused by getting it wrong.
Knowing how to reduce your own shoulder dislocation may be invaluable. One method that works for some people is called doing up the zip - you just take your bad hand in your good hand and bring it up as if it was a jacket zipper, until your hand is on your head.
- Getting the patient to relax their muscles will assist relocation Tim did this using the paddle to support his arms weight - this is an advantage of the self-help method.
- There is a tendency when a person swims to help by grabbing their gear as they swim to the side - people should always be dealt with first and we should never assume they'll be OK- even if they say the are they're probable too embarrassed to say otherwise).
- We should always know exactly what rescue gear is on hand before the trip starts.
- Everyone in the group should know escape routes - check a map beforehand. (Tim could have easily been driven out the 4WD track.)
For more information on shoulder dislocations and rehabilitation check out http://www.civilservicecanoeclub.org.uk/shoulder/.