Over-the-Side Speed rescue

The shoulder joint is formed by the junction of three bones: the collarbone (clavicle), the shoulder blade (scapula) and the upper-arm bone (humerus). The rotator cuff is the name given to the group of muscles and tendons that form a cuff that holds the head of the humerus in the glenoid fossa, a shallow socket in the scapula.
The structure of the shoulder joint provides an extraordinary range of motion. The only contact between the bones of the shoulder and those of the torso of the skeleton is at the joint between the clavicle and the top of the sternum, so the integrity of the shoulder joint comes almost entirely from the muscles that surround it. By allowing a wider range of motion than any other joint in the body, the shoulder is less stable than other joints, and two types of shoulder injuries are infrequent but well-known among paddlers.
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 only—options 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 left hand on the steering wheel and your left elbow by your side. Your right arm is extended and your right hand is hooked over the top of the passenger seat; your left shoulder is in a safe position—your right 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 practice the best exercise and paddling techniques to keep our shoulders safe and strong.
—Doug Anderson