Trained as a paramedic 37 years ago and we were taught to never reduce unless the radial pulse or neuro was compromised to the affected extremity. Later some 20 years in the emergency department assisted in a handful of reductions but always after x-rays ruled out fractures. Even then with medications on board it was not always easy for the physician to reduce. But I have to say having your shoulder reduced on site beats a long drive to the hospital with the shoulder pain exacerbated by turns and potholes. I think I remember it is more difficult to reduce with the passage of time because the surrounding muscles responding to the pain contract. Anyhow - great job. I enjoy your content and hope your buddy gets back on the river this season.

@WadeHarrison

2 жыл бұрын

Hey thanks for the feedback Brian seems you have way more experience with this then I have. So hearing this form someone that has a background in this I'm always welcoming! Thanks

@MicajahMcCurry

2 жыл бұрын

Brian, you've got us both beat in medical. But having dislocated 3 times on this exact river... Reseting it on the spot is a whole lot better of an option than the hour(s) of driving to the nearest hospital.

@WadeHarrison

2 жыл бұрын

@@MicajahMcCurry 100% true and I have a wilderness training expert coming on a podcast to explain all this.

@briand3837

2 жыл бұрын

@@MicajahMcCurry If my shoulder was dislocated I would allow Wade to have a go at it also. Just giving an alternative with rationale. The patients I saw in the ED were in a lot of pain and the slightest movement had them nearly in tears.

@briand3837

2 жыл бұрын

@@MicajahMcCurry Also I injured my shoulder 35 years ago though not a dislocation it still is not normal. Can't throw a ball anymore or shoot baskets but not bad enough that I would consider surgery. I still kayak but really careful about surfing.

All kayakers need to take a good WFR course to learn more about this common injury. I’ve taught WFR since the 80’s, and needed this help too! Be prepared and paddle safe.

@WadeHarrison

2 жыл бұрын

so true

In Maine, if you are more than 2 hours from definitive care (hospital or doctor) then you can reduce a dislocation with proper training (wilderness first responder, etc). It is very easy to be more than a couple hours from help when you are on the river. Every state will be different but I would strongly suggest anyone engaging in back-country activities like kayaking or climbing seek out a WFR course. It is well worth the money. Nice work!

@WadeHarrison

2 жыл бұрын

very true everyone should have some sort of experience in WFR

So glad there’s people like you on the river.

@WadeHarrison

2 жыл бұрын

hey thanks Tmac

As an Emergency Physician with a Certificate of Added Qualification in Sports Medicine I feel I should add my $0.02. First off, great job on the field reduction! I do I a shoulder presentation for the BWA every few years where I go over keeping a shoulder safe while paddling and field reduction techniques. Unlike the paramedic that commented, I’m a strong proponent for field reduction of a paddler’s dislocated shoulder if you are comfortable doing so even if you are roadside as in this case for multiple reasons. 1) Immediate pain relief. 2) The sooner a shoulder is reduced the easier it is to do so. Once they get to the ER sedation is usually required adding risk and a great expense. 3) Evac is orders of magnitude easier and more comfortable if the shoulder is reduced. I reduced a shoulder once below Triple Drop on the RFG and the paddler was able to paddle out. As the other doc said, first verify 1) distal pulse, sensation and function (hand) and 2) Intact sensation over the deltoid. Injury to the axillary nerve is a rare complication to shoulder dislocation / reduction and if you document intact circulation / sensation / function before and after reduction no one can blame you for causing further injury. Here is what I recommend: 1)Verify dislocation by mechanism and exam. Usually there is an obvious “step off” on the injured side compared to the usual rounded shoulder. Remove gear if you have to but often times this is not necessary if you learn what to look for. Learn the difference between a severe separation and dislocation if there was a fall - they can look and feel quite similar to the untrained eye. But in general, you can’t separate or break or bone with a bad paddle maneuver and previously offenders will just know. 2) Check sensation / function / circulation at the hand and sensation over the deltoid. 3) Do whatever it takes to relax the victim and gain their trust. Success for early reduction requires them to “give you their arm”. If they are spazzed out only a long Stimson will work. 4) Watch videos for Hennepin, Milch, Stimson, and Scapular Manipulation technique. Watch them as many times as you need to in order to become comfortable with each technique. 5) Start with Hennepin, talk the victim into relaxing and if their is someone else there have them massage the Supraspinatus to aid it in relaxing. Calm and soothing. Victim has to let it go. 6) After a few attempts at Hennepin, consider moving to Milch. Milch is a leverage technique and requires some force. I’m considering not teaching it any more and having boaters move to Stimson if Hennepin is unsuccessful for that reason. 7) Stimson will work 100% of the time with enough weight and enough time. I recommend 10-15 lbs or weight - doesn’t have to be exact. Rocks in a helmet or throw bag work great. It’s important to affix the weight to the wrist (tie or tape) - if the victim has to hold the weight they can’t fully relax. If you can’t find a suitable rock to lie on, try stacking boats against some trees / rock. Be careful that you aren’t occluding blood flow however - check capillary refill before and after applying weights. 8) Learn the Scapular Manipulation technique. It works wonderfully while the victim has weight applied (Stimson) and can speed up the process greatly. 9) To test reduction have the victim try to put injured side hand on the opposite shoulder. Can only be done when shoulder is reduced but they usually know and you’ll often feel the “klunk” of reduction if using a manipulation technique. 10) Recheck sensation at hand and deltoid, hand function and pulse / capillary refill. 11) Sling the shoulder or use an ACE wrap figure of 8 just above the elbow. The advantage of the the figure 8 is the victim has use of his injured side hand which can make the hike out much easier. The figure 8 alternates wraps around the trunk / arm above the elbow and just holds the humerus close to the trunk - all you need to do. 12) Medical follow up is required for an X-ray looking for a numeral head fracture and for PT referral. Shoulders almost always pop out again regardless of PT until a Bankart reconstruction unfortunately but never hear of payers never paying for it after first dislocation :( Learn to keep the shoulder safe. Highly recommend NOC Instructor Blog on Shoulder Safety.

@WadeHarrison

2 жыл бұрын

Wow Great Feedback Wes thanks for that! You for sure won the Comments section Holy S#*T

@kevinhill.8

2 жыл бұрын

Wes, thx for taking the time to explain all that! Gives me some great research to dig into. I recall learning that getting the victim to relax is a key aspect not to be overlooked, so I’m glad to hear you mention it too.

Nice job Wade - shoulder dislocations would be a great Shuttle Bus topic - risks, methods of resetting, the mechanics of what happens in a dislocation, etc. I have taken WFA training and am prepared for this type of river issue but many paddlers do not have the basic knowledge on what to do.

@WadeHarrison

2 жыл бұрын

yes for sure I recommend taking training

What you need to bring with you to be safe on the river: 1. PFD 2. Helmet 3. Throw Bag 4. Wade Harrison!

@WadeHarrison

2 жыл бұрын

hahha funny

Great job, Wade!

@WadeHarrison

2 жыл бұрын

thanks dean

Any day, any time, almost any place I'd paddle with you. You sir, are a gift to the paddling community.

@WadeHarrison

2 жыл бұрын

Dude thanks

Good work Wade!! Way to go beast mode Alex!!!

@WadeHarrison

2 жыл бұрын

yeah, being that he rolled up and still eddied out was good thing because to swim the next rapid with a shoulder out could have been very bad

Wow nice shoulder reset bro, well done!

@WadeHarrison

2 жыл бұрын

Thanks

ER nurse and kayaker here. Wade is the man. But when you say "reset " a shoulder...it's kinda like someone who doesn't kayak asking you if you "flip" your kayak. Just sayin :) But a REDUCTION is often very difficult to do in the field, and sometimes really hard even in a clinical setting without sedation. Well done.

@WadeHarrison

2 жыл бұрын

Haha I Completely agree with you Devan and I'm not a nurse or doctor I tried to put a title that would be commonly known but for boaters, but you are right everywhere i have seen it usually says the word REDUCTION. Thanks for the feedback

Good job Wade! As a physician I would have tried a different technique first...but you got it. The next step is to verify proper blood flow to the upper extremity and normal sensory and motor function. Perhaps a follow up video to discuss this type of injury and what to do if it happened on a self-support type trip would be good.

@WadeHarrison

2 жыл бұрын

hey Dax, Thanks for reply what would you recommended to try first?

@ADVengerMoto

2 жыл бұрын

@@WadeHarrison I tried to respond with a link but KZread doesn't seem to be liking it. I think you did a great job. I think it goes without saying that you have to diagnose that no fractures or other injuries are present. Not reducing the shoulder in the field and driving to an ER for imaging is not realistic in most cases. I can tell you if this happens to me while I'm kayaking... I want my shoulder reduced. So having some medical knowledge in the field is valuable. Recognizing that there will be connective tissue injuries to some degree less forceful methods should be attempted first (range of motion methods) and only if they fail should more forceful methods be attempted. People can Google Kocher's Method. It is critical to be aware of the neurovascular bundle and to make sure that it is not impinged. Check that sensation and muscle strength is normal. Passage of time does make it more difficult to reduce in most cases. Anyway, great job! Love your channel.

@MCsvbcrypto

2 жыл бұрын

@@WadeHarrison NOLS wilderness first responder also recommends the same range of motion method to reduce in the field. If you can get your hands on a WFR book it’ll have steps and tests for CSMs.

@WadeHarrison

2 жыл бұрын

@@ADVengerMoto yeah Dax I had to block links in comments I kept getting tons of spam links that would not stop so I turned off links you could post a url but not a link I appreciate all you have added to the comments

@WadeHarrison

2 жыл бұрын

@@ADVengerMoto also to add this video is edited there was way more that happened then was in the video we talked with him a bit and had him move it some I felt for where it was out i tried to get him to reset it himself by both hands on the knee and leaning back then moved him to the rock shelf I have been involved in reducing a few shoulders so this was nothing new to me dude is very strong

Good stuff Wade !!

@WadeHarrison

2 жыл бұрын

Thanks GUTH

You're a magician! Glad to have someone like you in the community! Hoping for Alex to have a speedy recovery!

@WadeHarrison

2 жыл бұрын

hey thanks jar yeah, I talked to him today he is already doing better

I can not tell you how many times I have had mine reset, by myself or someone else have done it, Dude you are awesome!👏

@WadeHarrison

2 жыл бұрын

dam buddy that doesn't sounds to fun and luckily, I have never had a shoulder issue from kayaking Outside a few tweaks and soreness I'm still saying it's from the crossbows keeps them loose

Wade, you are the man! Thank you for the speedy reactions and smooth reset.

@WadeHarrison

2 жыл бұрын

You staying in your boat and rolling up and not swimming and making it to the eddy for sure made things so much better buddy so many would have probably would have just bailed as soon ads they knew it was out like that

@alexsinger7469

2 жыл бұрын

@@WadeHarrison Thanks Man! I just knew swimming would make it way worse with junkyard below. This was my first time using an offside in over a year 😂.

@Sam-fh7qh

Жыл бұрын

@@alexsinger7469 hay Alex, just wanted to see how things are going with the shoulder I popped mine out 2 days ago and like you one of the guys got it back in very fast like under 3 mins, are you recovering well and do you mind me asking what you are doing to recover and to get back paddling good WW

What a great rescue job. Very well done, Wade !!!

@WadeHarrison

2 жыл бұрын

Thanks buddy

Well done Wade. Great job of dealing with a painful situation with a calm head. 👍

@WadeHarrison

2 жыл бұрын

hey thanks Mark

Great, really well done, Wade, its good to have you on the river.... If I was hin, would have cried like a little baby, You can calm the injured down and help them, very profesional 😎👍. Respect man

@WadeHarrison

2 жыл бұрын

Oh, he had some screams I did some editing, but I try to stay pretty calm when things like this happens and Alex was pretty tough with this.

I have a bad left shoulder that I severely dislocated probably 8 years ago in a fall at home. I have only been paddling whitewater for about 3 years and have had no problems with it, but I know that it could easily be dislocated again. The pain is immense. Kudos to you for being there for your friend and knowing what to do to fix the injury and ease his pain. I'm sure he will be eternally grateful.

@WadeHarrison

2 жыл бұрын

yeah, he already feeling better hopefully can paddle next few weeks

More proof you're the best dude 🤙🏽 And he's a badass. Hoping for a speedy recovery 🤙🏽

@WadeHarrison

2 жыл бұрын

Thanks Schaefer!

True river saint

@WadeHarrison

2 жыл бұрын

just something I'm sure we all would do

Can we acknowledge the POP sound when it went pack in... i have to go weep for a moment

@mountainhobbit1971

2 жыл бұрын

yeah that was intense.

@WadeHarrison

2 жыл бұрын

crazy I did not hear it there but when watching the video, I heard it loud

Anterior shoulder dislocations are about the easiest to reduce, but not always super easy, especially with a strong guy like that and being on the side of a river. Good job on getting it done quickly before inflammation kicked in and made it more difficult. Also good in making the PFD an impromptu sling and swath. Definitely good he's getting an MRI. With luck, it will pretty well heal itself (although he'll always be more susceptible to another dislocation).

@WadeHarrison

2 жыл бұрын

I know right he is not like a weak dude I actually tried it few times, but it didn't go the first one was like an easy pull the video looks like once, but it was on the third time, and I was like ok I'm going to really go this time and it worked he already feeling better

Wade, you are a superhero!

@WadeHarrison

2 жыл бұрын

I'm just helping out

Great job Wade ! Glad y’all all got out fine 🤙🏼

@WadeHarrison

2 жыл бұрын

thanks hunter

Some heroes wear skirts.

@WadeHarrison

2 жыл бұрын

I do have a kilt also for my Scottish Heritage 😜

@richardpowell1389

2 жыл бұрын

@@WadeHarrison Macgregor Clan?

@WadeHarrison

2 жыл бұрын

@@richardpowell1389 hahah he is Irish ☘️ im if the mccloud clan

Nice job. When I've seen it done that way in the ER, they usually just hang weight bags off the arm until it releases and pops back in. I hope dude went an saw an ortho doc though. There is too much going on in a shoulder joint, and he could have injuries that can't be diagnosed without imagining. Plus they can get him going with good solid rehab to get him boating again. One of the assessment points you can do before and after, is to evaluate feeling distal to the injury (moves fingers, and can feel). There is a pretty significant nerve plexus in the shoulder and if there is nerve damage you need a hospital ASAP. Well played Wade!

@WadeHarrison

2 жыл бұрын

He actually seen the doc today and they said it all looked good he has full movement and still some pain, but the doctors think resetting it quick helped a lot still going to go get a MRI to be on the safe side

Two awesome guys. Having the knowledge and skill to reduce that dislocation was clutch Mr. Harrison. Alex messaged me when he got home to let me know he too is on the injured list. : (

@WadeHarrison

2 жыл бұрын

Yeah It sucked I was going to show him down his first WFT lap next day he will get the summer one

Great job Wade!!! Sure wish our group could have seen this last week. I dislocated my shoulder on Jared’s knee and no one knew how to pop it back in. I know his pain.

@WadeHarrison

2 жыл бұрын

Oh dam dirty that sucks what did you do how did you reset it?

@dirtyskirts2965

2 жыл бұрын

Since we didn’t know how correctly we high tailed to an urgent care. And you know how them shuttle drivers are… hit a corner and I could feel it start to move. So I just pushed against the door and it slid right in and man you are right all the pain goes away immediately. Mines looking like surgery tho. Results back Wednesday. First trip of the year too.

Bro, no lie, out of everybody that I would want to paddle with one day, you are at the top of that list, seriously bro, you rock 💪💪💪

@WadeHarrison

2 жыл бұрын

Thanks DOP I appreciate that buddy

@yakob.simpson

2 жыл бұрын

Just don’t run shuttle with him and you be fine

@WadeHarrison

2 жыл бұрын

@@yakob.simpson Ever heard of the Irish goodbye at the takeout 😂

@yakob.simpson

2 жыл бұрын

@@WadeHarrison I can assume what that means 😂

What's most interesting is that he was able to roll up. Probably R handed and could use this dominant arm but really remarkable. Lucky to have a rock that he could lean over with his L injured arm hanging down. The rock stabilized his shoulder girdle (clavicle shoulder blade) so that all the downward force would be on the shoulder joint itself. Usually no sudden jerk force is needed but constant firm traction. Getting to the reduction so soon after injury might have made it much easier rather than after it became more painful with swelling. This maneuver can be reversed if necessary (no rock or picnic table) by lying face up with someone pressing down on the clavicle and the arm with gentle strong traction brought up slowly into same position as if he was lying face down. (straight up and not out). That was a great rescue reduction; you must have done it more than once. Thanks for interesting video. (can you imagine swimming in that water with a dislocated shoulder)

@WadeHarrison

2 жыл бұрын

he super solid at rolling on both sides and yeah, I agree maybe didn't need to jerk so hard but he very strong and it was tight so future will keep that in mind thanks for the feedback

I would definitely recommend always having someone in the group with qualified medical training when running class 4 and above...do you go through yearly training Wade?

@WadeHarrison

2 жыл бұрын

no mostly just self research and real world dealing with these things this is actually the 4 shoulder dislocation I have personally witness or helped with over the paddling years and have seen it reset many ways I have never done it till this day but knew there were a few ways to do it and it should be done quickly this is just one

😳

@WadeHarrison

2 жыл бұрын

Exactly

1st try!

@WadeHarrison

2 жыл бұрын

yup smooth as butter

Great job! Check out my video of doing the Cunningham technique. I think it should be the go-to for wilderness applications.

@WadeHarrison

2 жыл бұрын

Dude for sure that's the one you put their hand on your shoulder and then slowly push down on the elbow, right? I actually have seen this used before and probably should have done that first we still need to do that podcast and can talk about this.

@floydmiracle1258

2 жыл бұрын

@@WadeHarrison yep! Just have them grasp your forearm or place their arm on your shoulder and apply downward traction while massaging the deltoid.

@WadeHarrison

2 жыл бұрын

@@floydmiracle1258 thanks for the feedback Floyd look forward to covering this with you!

@jaredsimpkins1373

2 жыл бұрын

Yes Floyd knows his sh!t. I’ve been on a quite a few trips with Floyd, and just knowing he’s there makes me feel better.

Been there, done that, was not fun. Being in the shoulder club isn't something I recommend.

@WadeHarrison

2 жыл бұрын

how and where did you do it and how did they reset it?

@dangerjudy5334

2 жыл бұрын

@@WadeHarrison The first time I was goofing around on a class II wave and I went to the hospital to get it reset. The second time I was in LRC and had learned a way to reset it myself just in case. The way I learned is this: kzread.info/dash/bejne/hY5-sJdmpJnWZ8Y.html