A shoulder dislocation occurs when the upper arm bone (humerus) separates from the shallow socket of the shoulder blade (glenoid fossa). This separation causes immediate and intense pain. This technique describes a temporary first-aid stabilization method designed to prevent further injury during transport. A dislocated shoulder is a serious injury that requires immediate professional medical treatment, including X-rays and a controlled reduction procedure. Attempting to self-treat or manually reduce the dislocation is extremely dangerous and can cause permanent nerve or blood vessel damage.
Identifying a Dislocated Shoulder
Recognizing a shoulder dislocation is the first step in providing appropriate emergency care. The most telling sign is an obvious physical deformity of the shoulder joint. The normal rounded contour often appears “squared-off” or flattened, and a prominent bulge may be visible where the humeral head has shifted.
The patient will experience sharp, severe pain and will be unable to move the joint. They may also report a distinctive “pop” or tearing sensation at the moment of injury.
Essential Preparatory Steps
Never attempt to move, push, or “pop” the joint back into place. Forcing the joint can severely damage nerves, blood vessels, or surrounding soft tissues that may be trapped between the bones. Instead, position the person in the most comfortable way possible, usually sitting or standing with the arm supported against the chest.
Before applying any wrap, perform a neurovascular check to assess circulation and sensation in the injured limb. Check the color and warmth of the fingers and hand, compare the pulse at the wrist, and ask the person to wiggle their fingers. If the hand is pale, cold, or numb, or if the pulse is weak, this suggests possible nerve or vascular compromise that requires urgent medical attention. Gather materials like two large triangular bandages, a scarf, or wide strips of cloth; one will be used for the sling and the other for the swathe.
Step-by-Step Immobilization
The stabilization process uses a sling and swathe to immobilize the arm and gently secure it against the torso, preventing any movement of the shoulder joint during transport. The goal of the sling is to support the weight of the arm, and the swathe is to bind the arm against the body.
Creating the Sling
To create the arm sling, tie a knot in the point of a triangular bandage to create a small pocket for the elbow to rest in. Slide the bandage under the injured arm, with the knot positioned snugly at the elbow, and the top corner extending up over the shoulder on the uninjured side.
The bottom portion of the bandage is then brought up over the arm and across the chest to meet the other end at the collarbone of the injured side. Tying these two ends together at the collarbone, well away from the injured joint, completes the sling.
This sling should be adjusted so the hand is positioned higher than the elbow, which promotes venous blood return and helps reduce swelling in the hand. The fingertips should remain visible outside the sling to allow for continuous monitoring of circulation.
Applying the Swathe
Once the arm is supported in the sling, a swathe is applied using the second triangular bandage or cloth strip. The swathe is wrapped horizontally around the person’s chest and over the injured arm, binding the arm securely to the torso. This binding prevents the arm from swinging or moving away from the body, which is a common source of intense pain. Tie the swathe knot on the side of the body away from the injury or on the back, ensuring it is snug enough to restrict movement but not so tight as to restrict breathing.
Post-Stabilization Monitoring and Care
After the sling and swathe are secured, the neurovascular status of the hand must be monitored continuously until professional medical help is reached. Check the color and warmth of the fingers and ask about any new tingling or numbness every ten minutes. The return of color to the nail bed after a gentle squeeze should take no more than two seconds.
If the fingers become noticeably pale, cold, or if the person reports increasing numbness or tingling, the wrapping is too tight and must be slightly loosened immediately. Pain management while waiting for transport can include applying a cold compress or ice pack to the shoulder area, placed over the clothing and the wrap, if the person can tolerate it. Arrange for prompt transport to a medical facility, ensuring the person is kept as still and comfortable as possible during the move.