C&K mag #34 dps-f spg - Canoe & Kayak

Shoulder dislocations occur when there is an injury to the joint between the
humerus and scapula. Shoulder separations occur when there is an injury to
the joint between the clavicle and the acromion, an extension of the scapula.
When a shoulder traumatically dislocates, the top of the humerus is usually
displaced below and forward of its usual position in the glenoid fossa
(anterior dislocation). In far fewer cases, and unlikely in paddling-related
injuries, the top of the humerus is displaced to a position behind the shoulder
blade (posterior dislocation).
Typically, the significant pain of a dislocation starts about five minutes after
the incident. The pain starts as a dull throb and gets progressively worse. Soon
after the trauma, the muscles become tight and hold the shoulder in its injured
position. The muscles begin to spasm, and the victim will not find any
comfortable position for the arm. Without treatment, the pain can become
overwhelming, leading to debilitating shock, if not unconsciousness.
Treating Dislocations
Occasionally an injury to the shoulder may only temporarily dislocate the
humerus and allow it to return to its original position within the shoulder
joint. In this case, a supportive sling will serve to minimize discomfort and
prevent further injury until medical help is available. If the humerus remains
out of position, there are potentially very serious complications when treating
the injury. The pain and the damage will grow progressively worse, and
emergency medical assistance should be obtained as quickly as possible.
A hospital or appropriate clinic will choose the best of several procedures to
relocate the humerus into its shoulder socket. As with setting a broken bone,
the patient will be well-medicated to relieve pain and relax the tense and
spasmed muscles. Advanced wilderness first-aid courses may cover field
treatment of a dislocated shoulder, but believe me, I have witnessed four
anterior shoulder dislocations, and all of the victims were in severe pain. Any
field treatment would have been overwhelming and excruciating for everyone
involved. Typically, victims cradle their injured arm and aren’t inclined to let
any non-medical person move them. Some padding and a sling to support
the arm in its existing position are likely the safest-and maybe the onlyoptions
available prior to transporting the injured paddler to a medical facility.
A long process of healing and rehabilitation begins after the dislocation is
treated. The patient might be paddling again in three months, and it may take
up to a full year to regain normal strength and a full range of movement. The
shoulder may never be quite the same again. Patients who have sustained a
shoulder dislocation can develop chronic instability and often suffer recurring
dislocations. It may be necessary for surgery to tighten up and/or repair
torn ligaments.
Causes and Prevention
The shoulder is most stable when the elbows are positioned well below the
shoulder and are well bent. The shoulder is unstable and prone to traumatic
injury when the elbows are near or above the level of the shoulder. The
shoulder is most vulnerable to dislocation when the elbow is at, or above
shoulder level with the elbow behind the shoulder and the arm externally
rotated (palm rolled to face upward). The leverage on the arm the possibility
of dislocation is further increased when the arm is extended with a
straight elbow.
Imagine driving your car with your right hand on the steering wheel and your
right elbow by your side. Your left arm is extended and your left hand is
hooked over the top of the passenger seat; your right shoulder is in a safe
position-your left shoulder is not.
In a high brace, the wrists are above the elbows. Contrary to what the name of
the brace suggests, the working blade should remain as low possible, and the
hands shouldn’t be much above the shoulders. The forearm closest to the
working blade should remain near 90 degrees to the paddle shaft, and the
elbows should be well bent and near the torso. In a low brace, the same rules
for the arms and elbows apply, but the wrists are below the elbows. The very
common tendency in either brace is to extend the arm closest to the working
blade. That only reduces grip strength and places the shoulder in an unstable
and weakened position.
The remarkable range of motion in a shoulder provides us with the ability to
manipulate a paddle and control a sea kayak. Deprived of that joint’s supple
strength, our independent progress comes to a stop. We should all pay heed
to our shoulders and routinely practise the best exercise and paddling
techniques to keep our shoulders safe and strong.
12 ISSUE THIRTYfour • 2005
12 MARCH 2006
Run 13km
Cycle 58km
Kayak 19km
90 kilometres coast to coast across
the Auckland isthmus. From North
Head, Manukau Harbour on the
Tasman Sea, to North Head,
Waitemata Harbour on the Pacifi c
Ocean, the course is distinctive and
challenging. “Head to Head” is an
exciting race and also an adventure,
a journey of discovery through
Auckland’s surprisingly wild and
scenic places. Compete as an
individual or in a three person team.
For further information or an entry form,
contact the event organisers:
Nelson Associates,
P.O. Box 25 475, St Heliers,
Auckland. Phone (09) 585 1970,
email: nelson.as@clear.net.nz
www.head2head.net.nz