How does a shoulder dislocate:

Shoulder dislocations that happen in the river relatively occur the same way they happen on land. The arm gets into a “position of vulnerability” and a traumatic force overwhelms the structures holding the humeral head in the socket. The position of vulnerability is when the arm is abducted (away from the body) and externally rotated (the hand away from the body). It is the same position of someone throwing a ball. More than 90% of the time, the dislocation is anterior, meaning the humeral head comes out the front of the socket. Less commonly, the shoulder can dislocate posteriorly, out the back of the joint. This only occurs in about 3% of dislocations.

What to do:

If your shoulder has dislocated, it is very important to have it reduced as soon as possible.  If this is your first dislocation, immobilize your arm with a sling and get to the ER. A doctor there will obtain x-rays and evaluate the shoulder, ruling out any other possible injuries. Then the shoulder can be put back in place with a closed reduction. The longer the shoulder is dislocated, the harder it is to put back in place. If this is the case, it may require sedation to get the muscles to relax enough to put the humeral head back in the socket.  Once the shoulder is back where it should be physical therapy can help avoid a recurrent dislocation. Often, if the shoulder dislocates multiple times it requires a shoulder stabilization surgery.

Prevention:

While in the water, proper technique will help prevent a shoulder dislocation. Staying within the “paddler’s box” will lessen the strain that is placed on the shoulder and prevent you from reaching that position of vulnerability. Keep the elbows below shoulder level, the arms in front of your torso and the paddle away from your body. Check out this YouTube video for a great demonstration of what the paddler’s box looks like:

https://www.youtube.com/watch?v=7kssLXFN1vo 

Strengthening the musculature around the shoulder is very important as well. The rotator cuff, trapezius, deltoid, scapular muscles and chest muscles all work together to keep the humeral head in the socket.  Simple band exercises at home are great maintenance to help prevent injury.