A dislocated shoulder occurs when the head of the upper arm bone (humerus) is forced out of the shoulder socket (glenoid). This injury can damage surrounding soft tissues, including ligaments, tendons, muscles, nerves, and blood vessels. Immobilizing the arm is a temporary first aid measure used to stabilize the injury until professional medical treatment is received. Following a suspected dislocation, the primary focus must be on seeking immediate medical care, as only a qualified healthcare professional should attempt to reposition the joint.
Immediate Safety and Preparation
The most important action is to contact emergency medical services immediately. While waiting for help, keep the patient calm and still, avoiding any movement of the injured arm. Never attempt to push, pull, or “pop” the shoulder back into place. Relocation attempts by an untrained person increase the risk of complications, including tears to surrounding tissues or damage to nerves and blood vessels.
The goal of first aid is to stabilize the arm in the position of comfort, typically across the chest. Necessary materials include a triangular bandage for the sling, a wide cloth or elastic bandage for the swathe, and padding materials like rolled towels or gauze. Remove any jewelry from the injured hand or wrist proactively, as swelling often occurs, making rings or watches difficult to remove later.
Step-by-Step Stabilization Technique
The stabilization process uses a two-part system: a sling to support the arm’s weight and a swathe to secure the arm against the torso. First, gently position the injured arm across the chest, aiming for the elbow to be at roughly a 90-degree angle. The hand should be slightly elevated compared to the elbow to minimize strain on the joint while waiting for medical assistance.
Next, apply the sling using a triangular bandage or similar cloth. Place the sling material under the injured arm, with the point of the triangle directed toward the elbow. Bring the ends of the sling up around the neck and tie them securely on the uninjured side to distribute the weight. Ensure the knot is padded if it rests directly on the skin.
Once the sling supports the arm’s weight, apply the swathe to immobilize the upper extremity against the body. Use a wide elastic bandage or a second cloth to wrap horizontally around the chest and the injured arm. This wrap restricts the elbow and upper arm from moving away from the torso, preventing further displacement of the joint.
Before wrapping the swathe, place soft padding, such as a rolled sock or gauze, in the armpit area and between the arm and the chest. This padding prevents skin irritation and pressure points. The swathe should be snug enough to hold the arm firmly in place, but must not constrict breathing or circulation.
Monitoring Circulation and Waiting for Help
After the sling and swathe are in place, immediately check the circulation in the injured extremity. Perform a capillary refill test on the fingers of the injured arm. Gently squeeze a fingernail until it turns pale, then release the pressure; the normal pink color should return within two to three seconds.
A delayed return of color, taking longer than three seconds, suggests the wrap may be too tight and is impeding blood flow. Other signs of restricted circulation include the fingers becoming pale, blue, or cool to the touch. The patient may also report new or worsening numbness or tingling in the hand or fingers.
If any of these signs appear, the swathe must be loosened immediately and the circulation re-checked. Continue to monitor the patient’s circulation every 10 minutes while awaiting professional help. Applying an ice pack, wrapped in a thin cloth, to the outside of the shoulder joint can help reduce pain and swelling. The patient must remain as still as possible until medical transport arrives.