Time to reduce shoulder?

[OB1🤙]

So I went out and dislocated my shoulder this weekend, and it seemed like it took them waaaaaaaaaaaaaay too long for them to get around to putting this thing back in.

Put it this way- the injury happened at 11:15. I was at the hospital by 11:45. My shoulder wasn't reduced until 3:30. I was in 10/10 pain the whole time, which morphine didn't even dent, and I have a high pain tolerance. Now I know you gotta wait (and wait) for x-ray, etc etc, but the previous times I've done this, the ER fixed it as soon as I got to the hospital.

What pisses me off the most is that apparently I lost a cutaneous nerve in the process, and I can't feel the back of my shoulder. I wonder if this had been the case if I had been treated more promptly. I could feel the whole mess going into spasm while I was waiting. The nerve damage obviously could have happened due to the impact of the injury, but I've done this before without that kind of problem. Who knows.

Don't worry, I'm not asking this because I want a reason to sue. I'm not that kinda guy, and am really not interested in contributing to malpractice costs. But I just really want to know what is a normal time to reduction when a pt comes into an average ER in 10/10 pain, so maybe I can give the staff a little piece of my mind. Which wouldn't help anything, but still.

If it matters, I have 2 prior luxations, and this was at our private university hospital (and they knew I'm a med student there), not a busy trauma center or county hospital.

Also, I could be looking into going into EM, so this is not intended as an "EM sucks" thread. And this was not easy to write with one hand! Thanks...

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[Sessamoid]

I work in a tertiary care center/regional trauma hospital, and on average I'd say we get to dislocated shoulders considerably sooner than the nearly 4 hours you quote. That's the average, mind you. When we're pounded with traumas and x-ray is doing nothing but body parts that have bones sticking out of them for hours, then dislocated shoulders and the like obviously take a lot longer before we get to them.

Due to medicolegal reasons, few are willing to reduce a shoulder without x-ray first, the legal risk being that if a fracture is later found that one could be sued for supposedly causing it unless you had proof that it was caused by the original trauma. This despite the fact that the force used in reducing shoulders is not nearly enough to break a humerus. Thank the lawyers for that bit of time-consuming caution.

Most of the time, I'll have x-ray come and shoot a one-shot quick portable, then sedate for the reduction immediately.

Did you ask what the reason for the delay was? I'd at least give them a chance to explain before going off on them. If they can't give you a good reason, then go ahead and write a letter of complaint. If nobody complains, nothing changes. And don't think that letters from patients get ignored. At every hospital I know of, patient complaints are very high priority, especially if they're from well-insured patients.

 

[DrQuinn]

I would say that as long as X-ray isn't swamped, or trauma or medical resuscitations don't come in, I would be able to reduce your shoulder within an hour or hour and a half from initially seeing you. Should reductions are a lot of fun so I like to jump on those as soon as I can... mainly because i like to experiment with whatever conscious sedation drug I feel like that day (really liking just 10 of Etomidate!). Four hours in an extremely busy university ED is not unheard of. We had 40 patients in the waiting room for over 8 hours two days ago...

Q, DO

 

[OB1🤙]

Thanks for the replies, guys. Thing is, this wasn't a busy hospital. We have Tulane hospital (private) right next to Charity Hospital (speaks for itself) right next to the VA. So it's not like they were swamped with trauma or anything. As far as I could tell, it was a slow Sunday afternoon.

I did overhear (more than once) nurses ask each other "why is that guy still in there?" when I was waiting for x-ray. So it seems like this was a little out of the ordinary. I think I probably just happened to get each various service (transport, x-ray etc) at the worst possible time. Such is my luck.

At one point I saw the portable x-ray being wheeled around, and I should have piped up and demanded a portable instead of the hour it took for a round trip x-ray expedition.

Oh well. Watcha gonna do. At this point I'm just really hoping there's no motor damage to go along with sensory (don't think so, but haven't tried moving it yet). We shall see.

 

[Sessamoid]

Originally posted by Hawaiian Bruin

Oh well. Watcha gonna do. At this point I'm just really hoping there's no motor damage to go along with sensory (don't think so, but haven't tried moving it yet). We shall see.

Hope it turns out okay. Sensory deficits are not that uncommon with shoulder dislocations, and like all peripheral nerves, they regenerate VERY slowly. Motor nerve injuries with shoulder dislocations are very unusual, especially without an associated fracture.

 

[LostTommyGuns]

Good thing you had your trusty friend with you to hold your [good] hand